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108 Cards in this Set

  • Front
  • Back
hospice care,

-what is the criteria for admission?
-diagnosis with terminal illness with prognosis of 6 mo or less
hospice care, criteria for admission

who needs to be in agreement?
pt and family need to be in agreement
hospice care, criteria for admission

in order for the pt to live at home, what is required?
if it happens at home, you are required to have a primary care giver. if the symptoms become out of control, they can be admitted to an acute inpatient care)
hospice care, criteria for admission

-what part of medicare do they benefit under
medicare part A
hospice care, criteria for admission

does the doctor have to agree on the admission to hospice?
-the MD / medical director has to agree that it is an appropriate admission
becoming an effective communicator

what can you teach family members
teach signs that death is nearing, so maybe there is longer periods of apnea (when the body is shutting down, blood is shunted away to vital organs so you can see mottling/purplish spots on lower extremities, change in LOC, change in breathing -> teaching that empowers the family members
becoming an effective communicator

-how can you give them a sense of control?
-tell them what to expect at the time of death (that gives them a sense of control)
becoming an effective communicator

-end of life care decisions and the end is signs of impending death such as:
(physical signs)
becoming an effective communicator

there is an assumption that hospice nurses burn out faster than other areas (that’s not true..why?
because there is no ethical conflict about the care you are providing, your providing comfort measures alleviating someone’s pain and anxiety, you can visibly see positive results with symptom control, its an honor to be part of someone’s life during those last days)
becoming an effective communicator

-there is a lot of _____ intervention in hospice
crisis

(family goes into crisis during the pts death)
becoming an effective communicator

what to tell caregivers: information they value what 2 things

-during stressful periods they value what?
having control over the situation and the ability to predict changes (signs of impending death)
becoming an effective communicator

-repeat information __times during high stress periods
6
becoming an effective communicator

-when the family is freaking out and really stressed, you need to do what?
reign them in and get them to focus on the here & now
becoming an effective communicator

-having information about the patient’s condition improves _______outcomes and family satisfaction with hospice care
bereavement
becoming an effective communicator

-during stressful periods, 2 factors seem to make things more bearable:
1) the ability to have, or believe on can have, some control lover the situation

2) the ability to predict changes
becoming an effective communicator

information and education from the hospice nurse can improve a family’s sense of control by to do what with the pt?
enabling them to make most of the time they have with the pt
becoming an effective communicator

when the family seeks answers, a 2 step approach may be helpful:
1) focus the family on the here and now, living one day at a time.

2)offer clinical data based on physical examination, point out any changes from which family and pt can draw conclusion
Counsel about anticipatory grieving
-also called
anticipatory mourning
Counsel about anticipatory grieving

when does the grieving occur?
-grieve before the physical loss actually happens
Counsel about anticipatory grieving

what disorder is this commonly seen with?
common with Alzheimer’s/dementia –they don’t know their family member and that’s the hardest loss. at the time of death they may feel a sense of relief
Counsel about anticipatory grieving

-why may some family members withdraw?
because they can’t handle it and they are judged by the staff but that is their way of coping
Counsel about anticipatory grieving

-it can help if you involve the family in care. inpatient, family can help with personal cares or as much as possible. the more you can involve them, the better they feel and the more in control they feel
-it can help if you involve the family in care. inpatient, family can help with personal cares or as much as possible. the more you can involve them, the better they feel and the more in control they feel
Counsel about anticipatory grieving


what do we do w/ anticipatory guidance?
get the person to talk about it (validate what they are experiencing, normalize it, give coping strategies)
box 32-2 signs of anticipatory grief (extreme emotions –)
assess for anticipatory grief
Counsel about anticipatory grieving

common emotional experience was
anger (at the disease, medical community, others, life)

in addition to the sadness, hurt, fear, anxiety, and grief
Explain the following nursing interventions identified by Doka (2001) that provide support for persons experiencing anticipatory grief:

1. validate expression of anticipatory grief...
listen, understand, accept, and explain the grieving process which can be freeing for the griever. Be open to whatever they are experiencing at that moment and help them to feel comfortable with healthy expressions of anticipatory grieving.
Explain the following nursing interventions identified by Doka (2001) that provide support for persons experiencing anticipatory grief:

2-inform patients and families about the disease and its symptoms-
assist family to interpret and accept limitations as inevitable during end of life care given.
Explain the following nursing interventions identified by Doka (2001) that provide support for persons experiencing anticipatory grief:

3-
invite patients and families to deal with emotional issues-
encourage appropriate expressions of feelings within the family. Notice and appreciate peoples’ expressions of grief, even if they do not match your preconceptions. Feelings can be elicited with phrases such as “other people in your situations have told me they feel (sad guilty angry hopeless) have you experienced that?
Explain the following nursing interventions identified by Doka (2001) that provide support for persons experiencing anticipatory grief:


4-acknowledge the losses an changes in their lives-
many losses accumulate gradually and almost imperceptibly. Simply asking, in what ways has your own life changed since the diagnosis? Can permit people to identify and begin to cope with these losses and to see how far they have already come
Explain the following nursing interventions identified by Doka (2001) that provide support for persons experiencing anticipatory grief:


5-explore ways of coping-
examining both productive and unproductive ways of adjusting to change can be helpful. Strategies for using available help, taking time off form care giving duties, and distracting from grief can increase opportunities for respite and relief for both patients and caregivers
signs of anticipatory grief:
-feelings of emptiness or of being lost

-a sense of being numb and fatigued

-a feeling of unreality and disbelief

-periods of weeping or raging

-a desire to run away from the situation

-a need to protect the pt from suffering or death by overseeing every detail of care

-worry about the future and the unknown

-anger at the pt, medical professionals, or both

-pronounced clinging to or dependency on the pt or other family members

-fear of going crazy
Four tasks of mourning-for the bereaver
1 accept reality of loss

2 experience the pain of grief

3 adjust to the envt without the loved one (externally, internally, and spiritually)

4 relocate and memorialize the loved one (relocate mentally/emotionally and organize)
phenomena experience during grieving /

phenomenon during bereavement:
know that people can have physical (somatic) symptoms and that is normal during grief. a lot of people express psychological symptoms as a physical symptoms
phenomena experience during grieving /

know headings / print p. 717

-the more you can normalize the 6 headings being common with the one who is grieving the less distress they will feel
-sensations of somatic distress

-preoccupation with the image of the decreased

-guilt

-anger

-change in behavior: depression, disorganization, restlessness

-reorganization of behavior directed toward a new object or activity
Maladaptive Grieving: factors that complicate grieving

occurs when grief lasts how many months or more? and what else does it do to the person?
-grief that lasts 6 mo or more after the loss and bereavement that impairs ones ability to function
Maladaptive Grieving: factors that complicate grieving

highest risk factor for maladaptive grieving:
loss of a child (people who have experience that say you never get over it, but you learn to live with it)
Maladaptive Grieving: factors that complicate grieving

factors that complicate bereavement: (3 medical/psychriatric conditions)
depression, PTSD, substance abuse for certain.
Maladaptive Grieving: factors that complicate grieving

factors that put you at greater risk for dysfunctional grieving:
how dependent the person was on the decreased can increase the risk for dysfunctional grieving, lack coping skills, feeling ambivalence in the relationship (closeness, distance, conflict, harmony, the quality of the relationship, anger), the age of deceased b/c the younger the person is who dies, the more the family member feels it was unjust, esp if it was the loss of a child, unresolved conflicts, the number of previous losses (and how close the losses occurs and how many losses their were) as loss after loss piles up, it wears one down and sometimes people feel like they can’t take anymore), if death is associated with violence (bullet going through the wall killing a child, gang member killing a family member, car accident)
Maladaptive Grieving: factors that complicate grieving

proposed diagnostic criteria for complicated grief are:

-3
persistent pinning for a lost person

2) grief that lasts a period of 6 months or longer after the death

3) bereavement that seriously impairs the mourner’s ability to function in domestic and occupational roles
Maladaptive Grieving: factors that complicate grieving


indications that a person may have the potential for dysfunctional grieving may be determined by careful assessment. factors that can complicate bereavement are:
heavy emotional dependence on the decreased

2. unresolved conflicts b.w the bereaved and the decreased

3. young age of the decreased (often the most profound loss) or of the bereaved

4. lack a meaningful relationship or support system

5. history of previous losses

6. lack of sound coping skills

7. a death that was associated with a cultural stigma (HIV, suicide)

8. a death that was unexpected or associated with violence (murder, suicide)

9. history of depression, drug or alcohol abuse, or other psychiatric illness
Maladaptive Grieving: factors that complicate grieving

-what is the most common response to unresolved grief
prolonged depression
Maladaptive Grieving: factors that complicate grieving

what is disenfrancised grief-“
the grief a person experiences when they incur a loss that is not and cannot be openly acknowledged, publicly mourned, or socially supported” Ex: grief felt by health care workers over the loss of a patient, as well as grief over deaths by abortion or miscarriage, suicide and substance abuse, death of friends, divorced partners, and even animal companions
Cultural and Mental Health

serious MI occurs in all cultures but that is expressed differently in different cultures

whats an example?
people from Puerto Rica, Haiti may expresses MI somatically with body complaints)
Cultural and Mental Health


-western culture considers __________ as causing MI
neurochemcial disturbances
Cultural and Mental Health
in ________culture, eye contact is a sign of respectful attention, but in many other cultures, it may be considered arrogant and intrusive
american
Cultural and Mental Health

-in _______culture, emotional expressiveness is valued, but in other cultures it may be a sign of immaturity
western
Cultural and Mental Health

in __________culture, independence and self reliance are encouraged, and the family interdependence valued by other cultures may be seen as a symbiotic relationships or a pathological enmeshment
american
Cultural and Mental Health

-the cultures worldview, beliefs, values, and practices are transmitted to its members in a process called
enculturation
Cultural and Mental Health


-deviance from cultural expectations is considered to be a problem and frequently is defined by the cultural group as ________
illness”
Cultural and Mental Health

The universal tendency of humans to think their way of thinking and behaving is the only correct and natural way, is also known as:
- ethnocentrism:
Barriers to quality Mental health Services

what is the first barrier to quality care?

what is the second barrier?
first barrier to quality care is language,


the 2nd barrier is misdiagnosis (there are not a lot of assessment tools that accommodate various cultures)
Barriers to quality Mental health Services

How does an interpreter act as a cultural broker?
In addition to interpreting the language, the interpreter can alert the nurse to the meaning of nonverbal communication patter and cultural norms that are relevant to the encounter. In this way, the interpreter acts as a cultural broken, interpreting not only the language but also the culture
Barriers to quality Mental health Services

What are the disadvantages of using family members as interpreters for clients with limited English proficiency and mental health problems?
The stigma of mental illness may prevent the openness needed during the encounter, they may not have the language skills necessary to meet the demands of interpretation, which is a very complex task. Languages frequently cannot be translated word for word
Barriers to quality Mental health Services

What is the common cause of misdiagnosis of psychiatric illness in culturally diverse groups?
One reason is the use of culturally inappropriate psychometric instruments and other diagnostic tools. Most available tools have been validated using subjects of European origin. There current scales measure western ways of expressing depression by focusing on the affective domain, whereas for Koreans, more attention needs to be given to the somatic domain
Barriers to quality Mental health Services

What is a culture-bound syndrome?
A set of s/s that are common in a limited number of cultures but virtually nonexistent in most other cultural groups
What is the significance of ethnopharmacology?
The relatively new field of ethnopharmacology investigates the genetic and ethnic variations in drug pharmacokinetics. Many drugs are metabolized at least in part by P450 enzymes present in human beings, genetic variations in these enzymes may alter drug metabolism, and these variations tend to be propagated through racial and ethnic populations
What are the implications of people of African and Asian origin having less CYP enzymes than those of European origin with respect to antidepressants and antipsychotics?
Most antidepressants and antipsychotics are metabolized by CYP enzymes. Some genetic variations result in rapid metabolism, and if medications are metabolized too quickly, serum levels become too low and therapeutic effects are minimized.

If medications are metabolized too slowly, serum levels become to high and intolerable side effects are increased
-ethnic variation in how people metabolize meds (that’s a barrier to quality care)
-ethnic variation in how people metabolize meds (that’s a barrier to quality care)
Culturally Competent Care
-defined as adapting to the clients

-which allows what?
needs and preferences



(to increase adherence to the treatment plan)
Culturally Competent Care

-cultural competence means that nurses adjust what?
their practices to meet their patient’s cultural beliefs, practices, needs, and preferences.
Culturally Competent Care

what 2 things are essential components of cultural competent care
-having cultural sensitivity or awareness
Culturally Competent Care


what is the blueprint for psychiatric mental health nurses in providing culturally effective care:
the process of cultural competency in the delivery of healthcare services
the process of cultural competency in the delivery of healthcare services

-in this model, nurses view themselves as what?
BECOMING culturally competent rather than BRING cultural competent
the process of cultural competency in the delivery of healthcare services


this model suggests that nurses must constantly see themselves as
learners throughout their careers –always open to, learning from, the immense cultural diversity they will see among their patient’s.
-the model consists of 5 constructs that promote the process and journey of cultural competency
1. cultural awareness

2. cultural knowledge

3. cultural encounters

4. cultural skill

5. cultural desire
Cultural skill” leninger and mcfarland (2006) framework for planning care

-incorporates 3 things:
preserve, accommodate, restructure
Cultural skill” leninger and mcfarland (2006) framework for planning care

preserve:
1) you preserve the cultural practices that promote health and recovery (allow the practices to continue)
Cultural skill” leninger and mcfarland (2006) framework for planning care

accommodate:
2)accommodate cultural beliefs and practices that may or may not be helpful but they are not harmful
Cultural skill” leninger and mcfarland (2006) framework for planning care

restructure
3) restructure problems that are problematic (herbs interacting with drugs) anything that is harmful or anything that would inhibit recovery
Cultural skill” leninger and mcfarland (2006) framework for planning care

effective nursing care preserves the aspect of the patient’s culture that, from a Western perspective, promote health and well-being, such as a strong family support system and traditional values like cooperation, and emphasis on relationships
effective nursing care preserves the aspect of the patient’s culture that, from a Western perspective, promote health and well-being, such as a strong family support system and traditional values like cooperation, and emphasis on relationships
Cultural values and practices that are neither helpful or harmful are accommodated or may be negotiated.

--You may encourage the patient’s use of neutral values and practices, such as folk remedies and healers. By including these culture-specific interventions in the care as complementary interventions, nursing care builds on the patient’s own coping and healing systems.
Cultural values and practices that are neither helpful or harmful are accommodated or may be negotiated. You may encourage the patient’s use of neutral values and practices, such as folk remedies and healers. By including these culture-specific interventions in the care as complementary interventions, nursing care builds on the patient’s own coping and healing systems.
When cultural patterns are determined harmful, the nurse must make attempts to repattern/restructure them. For instance, if a patient is taking an herb that interferes wit the prescription medication regimen, you will do well to educate and negotiate until a mutually agreeable therapeutic program is developed
When cultural patterns are determined harmful, the nurse must make attempts to repattern/restructure them. For instance, if a patient is taking an herb that interferes wit the prescription medication regimen, you will do well to educate and negotiate until a mutually agreeable therapeutic program is developed
Which phase of grief is the acute stage of mourning, when a person begins to feel intense feelings of anguish and despair and may exhibit anger, guilt, and tearfulness?
A) Shock and disbelief
B) accepting the reality
C) Restitution
D) Bereavement
B) accepting the reality
As awareness develops, the denial prominent in the stage of shock and disbelief fades and painful feelings surface.
Text page: 717
The nurse providing end-of-life care will best engage in healthy self care by:
A) Adhering to the patient's careplan once it has been created.
B) Being flexible in what you are willing/capable of doing for your patients.
C) Self reflecting on personal feelings/emotions often.
D) Remainingdetached in order to provide effective care.
C) Self reflecting on personal feelings/emotions often.

Self reflection will encourage you to be aware of how your work is impacting you physically and emotionally.
Text page: 714
A grieving wife tells the nurse "If his boss had not been so hard on him, he would not have had the heart attack. I will always blame his death on his job and that boss who rode him so hard and made him work so much overtime." Which of the normal phenomena experienced during the mourning process does this statement exemplify?
A) Preoccupation with the deceased
B) Disorganization and depression
C) Anger
D) Guilt
C) Anger

Anger is exemplified in these statements in which the wife blames her husband's boss for causing the husband's heart attack.
Text page: 717
Studies have shown that individuals contemplating end-of-life issues commonly fear
A) becoming a burden.
B) leaving money unspent.
C) being able to direct and control care.
D) the inability to display strong feelings toward family.
A) becoming a burden.

Individuals typically fear becoming a burden, being abandoned, being in pain, becoming impoverished, and becoming undignified in how they look and smell.
Text page: 711
Which statement about palliative care could the nurse use to provide an explanation to a dying client and his or her family?
A) Palliation addresses emotional and spiritual pain to a greater degree than physical pain.
B) Palliation focuses on aggressive holistic comfort care when a cure is no longer a goal.
C) Clients receiving palliative care can expect no discomfort at the end of life.
D) Clients receiving palliative care will be released from end-of-life decisions.
B) Palliation focuses on aggressive holistic comfort care when a cure is no longer a goal.

Palliative care aggressively addresses physical, emotional, social, and spiritual pain when a cure is no longer a goal.
Text page: 708
The most accurate way of describing nursing of the dying is that it is
A) facilitative.
B) directive.
C) structured.
D) stressful.
A

The nurse caring for a dying client must be more facilitative than directive if the client's wishes are to be followed. Dying is an active process in which goals constantly require adjustment as the client's physical and emotional states change.
Text page: 722
The best approach to talking with a dying client about his or her future death is to
A) follow the client's leads.
B) ask direct questions.
C) avoid the topic of dying.
D) talk about dying in indirect ways.
A) follow the client's leads.
The client's ability to face his or her death will vary from day to day or even hour to hour. The nurse must follow the client's leads or risk confronting the client with unwanted information or, at other times, avoiding questions.
Text pages: 709, 710
The two factors that seem to help dying clients and their families most are the ability to
A) have control and predict changes.
B) express anger and disconnect from emotion.
C) attend a bereavement group and vocalize negative feelings.
D) express guilt and establish a structured daily routine.
A
When the nurse transmits information to dying clients and their families, the process should include
A) a short session in which abbreviated information is given.
B) two sessions, one for the client and one for the family.
C) an initial session, a review session, and a time for questions.
D) oral and written information provided in at least six reiterations.
D
Which statement would be evaluated as indicating risk for unsuccessful work of mourning?
A) "He was a wreck when his brother died. He cried several times. It took months before he acted like his old self."
B) "I remember the good times we had together as well as the rough days we went through before she died."
C) "She was so strong. She didn't shed a tear when anyone was around. Even now she just acts as though nothing different has happened."
D) "She went through a stage where she was very angry at the doctors and nurses who were not able to save her husband's life
C) "She was so strong. She didn't shed a tear when anyone was around. Even now she just acts as though nothing different has happened."


Crying is expected during the acute stage of grieving. A person who is unable to cry may have difficulty in successfully completing the work of mourning.
Text page: 718
A grieving husband tells the nurse "There were so many things I should have told her before she died. How much she meant to me, what a good wife and mother she was." Which of the normal phenomena experienced during the mourning process does this statement exemplify?
A) Preoccupation with the deceased
B) Disorganization and depression
C) Anger
D) Guilt
D
A woman whose mother has just died a painful death from cancer tearfully tells the nurse that she does not think she will ever get over her mother's death. The most appropriate response would be
A) "The next few months will be very hard for you, but in a year you will feel fine again."
B) "It was for the best. She was in such great pain."
C) "Time heals all wounds, and yours will heal also."
D) "The loss must be very painful for you."
D
A woman whose mother has just died a painful death from cancer tearfully tells the nurse that she does not think she will ever get over her mother's death. Which factor in her situation would facilitate the mourning process? She
A) acknowledges that her relationship with her mother was often stormy.
B) lost her job 2 months ago, and she and her husband have recently separated.
C) is a good problem solver and has many friends she can count on to listen and offer support.
D) has often reported physical symptoms that interfered with her work and social life.
c

The ability to solve problems suggests she will be able to restructure her relationships and reinvest in other relationships. Having a good support system will probably provide her with help in accomplishing routine matters and empathetic listeners.
Text page: 716
The client most at risk for dying in pain is
A) an executive who is used to being in power.
B) an immigrant whose culture is stoic regarding death.
C) a 4-year-old.
D) An Alzheimer's patient.
D
A client has been admitted for hospice care. The health care team who planned his care advise him to have radiation therapy to shrink a chest tumor and allow him to breathe more easily. The client does not wish to undergo this treatment. How will this controversy be resolved?
A) The client's wishes will prevail.
B) The recommendation of the health care team will be taken.
C) A consultant will be called in to give a definitive opinion.
D) The dispute will be settled by the ethics committee.
A

The hospice principle supports client control and choice.
Text page: 708
A client tells the nurse that her relationship with her terminally ill mother has seldom been a harmonious, loving one. She states she wishes things could have been different. The nurse could explain to the client the use of
A) the Four Gifts.
B) premourning.
C) anticipatory grieving.
D) recognition of a transcendent realm
A

The four gifts refer to simple tools for identifying distress and expressing it in a healthy way by making use of forgiveness, expression of love, gratitude, and saying farewell.
Text page: 712
A client tells the nurse "I am worried about my 70-year-old mother. My father died almost 9 months ago, and she is still not her old self. She says she is lonely, but she doesn't do anything about getting out and being with others." The most helpful remark for the nurse would be
A) "I think you are right in being concerned about your mother. Restitution should be taking place."
B) "At about this time in the grieving process people experience disorganization and aimlessness."
C) "It's odd that she is not talking a lot about your father and the good life they shared as a way of holding on."
D) "Because of her age, she may never release from her husband and be ready to take on a new relationship."
B) "At about this time in the grieving process people experience disorganization and aimlessness."


Teaching the family about the normal phenomena experienced during bereavement is helpful. This statement is the only option that reflects a fact about the bereavement process. Disorganization, depression, restlessness, and aimlessness precede reorganization of behavior and are generally most pronounced at 6 to 9 months.
Text pages: 715, 716
Nursing interventions that facilitate the grieving process include
A) insisting that the bereaved seek spiritual guidance.
B) helping the bereaved suppress strong emotions.
C) making eye contact and listening attentively.
D) not letting long periods of silence occur.
C) making eye contact and listening attentively.


Eye contact lets the bereaved know you are there and share their sadness. Patient listening helps the bereaved express feelings, both positive and negative.
Text page: 712
Which statement best explains the term "worldview"?
A) Beliefs and values held by people of a given culture about what are good, right, and normal.
B) Ideas derived from the major health care system of the culture about what causes illness.
C) Cultural norms about how, when, and to whom illness symptoms may be displayed.
D) Valuing one's beliefs and customs over those of another group.
a


A world view is a system of thinking about how the world works and how people should behave in the world and towards each other. It is from this view that people develop beliefs, values and the practices that guide their lives.
Text page: 102
Cultures develop norms to be consistent with their worldview and to adapt to their historical experience and the influences of the "outside" world. When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called
A) enmeshment.
B) ethnocentrism.
C) enculturation.
D) cultural encounters.
c

Members of the group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation.
Text page: 106
A cause of illness according to the Western scientific view of health is
A) pathogens.
B) energy blockage.
C) spirit invasion.
D) soul loss.
a


Disease has a cause (pathogens, toxins, etc.) that creates the effect; disease can be observed and measured.
Text page: 104
Which healing practice is least used in the Western health system of healing practices?
A) Antibiotic medication
B) Surgery
C) Targeted cellular destruction
D) Restoring lost balance or harmony
d

Best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.
Text page: 104
Exclusive use of Western psychological theories by nurses making client assessments will result in
A) a high level of care for all clients.
B) standardizing nomenclature for psychiatric disorders.
C) inadequate assessment of clients of diverse cultures.
D) greater ease in selecting appropriate treatment interventions.
c

Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs as to what will provide a cure are better.
Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of
A) biased assessment tools.
B) insensitive practitioners.
C) culturally insensitive interviewing techniques.
D) lack of the availability of cultural translators.
c

Inaccurate information or insufficient information may be obtained when the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.
Text page: 109
In the Eastern tradition disease is believed to be caused by
A) fluctuation in opposing forces.
B) outside influences.
C) members being disobedient.
D) adapting Western beliefs.
A
Deviance from cultural expectations is considered by members within the cultural group as
A) hostility.
B) lack of self-will.
C) variation from tradition.
D) illness.
d

Deviance from cultural expectations is considered, by others within the culture to be a problem and is frequently defined by the cultural group as "illness."
Text page: 106
A client tells the nurse "I think my symptoms started when I saw an older woman staring at me as I was shopping. I think she may have cast a spell. I must be cleansed." The assessment the nurse can make is that the client
A) has a major mental illness.
B) is expressing a culture-bound illness.
C) requires hospitalization to protect the "older woman."
D) will probably seek acupuncture as a way of treating her symptoms.
b

Many culture-bound illnesses—like ghost illness or hwa byung—seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western understanding of disease and illness.
Text page: 109
The Eastern worldview can be identified by the belief that:
A) One's identify is found in individuality
B) Holds responsibility to family as central
C) Time waits for no one
D) Disease is a lack of harmony with the environment
B) Holds responsibility to family as central

The eastern traditional worldview is sociocentric. Individuals experience their self-hood and their lives as part of an interdependent web of relationships and expectations.
Text page: 104
Which idea held by the nurse would best promote the provision of culturally competent care?
A) Western biomedicine is one several established healing systems.
B) Some individuals will profit from use of both Western and folk healing practices.
C) Use of cultural translators will provide valuable information into health-seeking behaviors.
D) Need for spiritual healing is a concept that crosses cultural boundaries.
A) Western biomedicine is one several established healing systems.
A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.
Text page: 112
When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects
A) supernatural causes.
B) negative forces.
C) inheritance.
D) imbalance.
d
Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces?
A) Acupuncture
B) Dietary change
C) Religious ritual
D) Herbal medicine
C) Religious ritual


Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces.
Text page: 109
The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports
A) increased somatic expressions of distress.
B) disruption of energy balance.
C) appeasement of spirits.
D) increased anxiety.
C) appeasement of spirits.
Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety.
Text page: 109
The nurse assesses the wellness beliefs and values of a client from another culture best when asking:
A) "What do you think is making you ill?"
B) "What do you think will make you better?"
C) "How can I help you get better?"
D) "Did you do something to cause the illness?"
A) "What do you think is making you ill?"

Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.
Text page: 113
Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture?
A) "Do you have a special person in your community who usually cures your illness?"
B) "What usually helps people who have the same type of illness you have?"
C) "What questions would you like to ask about your condition?"
D) "What sorts of stress are you presently experiencing?"
B) "What usually helps people who have the same type of illness you have?"




Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.
Text page: 113
Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to
A) health practices.
B) power and control.
C) psychological stability.
D) assimilation and conformity.
b

Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power.
Text pages: 107, 108
The psychiatric nurse planning and implementing care for culturally diverse clients should understand
A) holistic theory.
B) systems theory.
C) adaptation theory.
D) political power theory.
a

In most cultures a holistic perspective prevails, one without separation of mind and body.
Text page: 104 and 108