TRANCSCULTURAL GOAL, CONCEPT AND PURPOSES

TRANSCULTURAL NURSING

-is a specialty in Nursing focused on the comparative study and analysis of different cultures and
subcultures.

-Various groups are examined with respect to their caring behavior, nursing care, health and illness
values, beliefs and patterns of behavior

A. TRANCSCULTURAL GOAL, CONCEPT AND PURPOSES TRANSCULTURAL NURSING

-Transcultural Nursing is how professional Nursing interacts with the concept of culture. Based in
anthropology and nursing, it is supported by nursing theory research, and practice.

GOALS

>TO GIVE CULTURALLY CONGRUENT NURSING CARE,

> AND TO PROVIDE CULTURE SPECIFIC AND UNIVERSAL NURSING CARE PRACTICES FOR THE HEALTH
AND WELL-BEING OF PEOPLE OR

>TO AID THEM IN FACING ADVERSE HUMAN CONDITIONS, ILLNESS OR DEATH IN CULTURALLY
MEANINGFUL WAYS.

CONCEPTS

(A) ACCORDING TO STOKES (1991)

-NURSING PROFESSION IS NOT CULTURALLY FREE BUT RATHER IS CULTURALLY DETERMINED.

-TRANSCULTURE NURSING IS PROVIDING CLIENT CENTERED COMPETANT CARE TO CLIENT FROM

VARIOUS CULTURAL BACKGROUND.

(B) MADELIENE LEININGER

-A HUMANISTIC AND SCIENTIFIC ONSET OF FORMAL STUDY IN NURSING, WHICH IS FOCUSED UPON
DIFFERENT AMONG CULTURES WITH RESPECT TO CARE AND TO USE THIS KNOWLEDGE TO PROVIDE
CULTURE SPECIFIC NURSING CARE.

-TRANSCULTURAL NURSING HELPS THE NURSES TO DEVELOP THE KNOWLEDGE AND SKILLS NEEDED TO
PROVIDE CULTURALLY SENSITIVE CARE. CONCEPTS PURPOSES

> CULTURAL BACKGROUND AFFECT A PERSON’S HEALTH IN ALL DIMENSIONS, SO THE NURSE SHOULD
CONSIDER THE CLIENTS CULTURAL BACKGROUND WHEN PLANNING CARE.

> PROVIDES RESOURCES FOR ENCOUNTER WITH ILLNESS, SUFFERING AND DEATH.
> TO FOSTER UNDERSTANDING, RESPECT AND APPRECIATION FOR THE INDIVIDUALITY AND DIVERSITY
OF PATIENT BELIEFS.

> CULTURAL BACKGROUND AFFECT A PERSON’S HEALTH IN ALL DIMENSIONS, SO THE NURSE SHOULD
CONSIDER THE CLIENTS CULTURAL BACKGROUND WHEN PLANNING CARE.

> PROVIDES RESOURCES FOR ENCOUNTER WITH ILLNESS, SUFFERING AND DEATH.

> TO FOSTER UNDERSTANDING, RESPECT AND APPRECIATION FOR THE INDIVIDUALITY AND DIVERSITY
OF PATIENT BELIEFS.

PURPOSES

PURPOSES

> TO STREGTHEN THEIR COMMITMENT TO RELATIONSHIP CENTERED MEDICINE THAT EMPHASIZES CARE
OF THE SUFFERING PERSON.

> TO FACILITATE IN RECOGNIZING THE ROLE OF THE HOSPITAL AND THE PATIENT AS PARTNERS IN
PROVIDING CARE TO PATIENT.

>TO ENCOURAGE IN DEVELOPING AND MAINTAING A PROGRAM OF PHYSICAL, EMOTIONAL AND

SPIRITUAL SELF CARE INTRODUCE THERAPIES.

B. FOUNDER OF TRANSCULTURAL NURSING

Madeleine Leininger

In 1950’s Medeleine M. Leininger, known as the foundress of Transcultural Nursing, noted cultural
differences between patients and nurses while working with emotionally disturbed children.

B. FOUNDER OF TRANSCULTURAL NURSING

Madeleine Leininger

This experience led to study clinical difference in perception of the care.

She recognized that health and illness states are strongly influenced by culture and formulated the
theory of Transcultural Nursing

B. FOUNDER OF TRANSCULTURAL NURSING

Madeleine Leininger

>Transcultural nursing was established from 1955- 1975

>In 1975, Leininger refined the specialty through the use of ‘Sunrise model’ concept
>It’s international establishment as a field in nursing continued from 1983 to the present

B. FOUNDER OF TRANSCULTURAL NURSING

Madeleine Leininger

THE SUNRISE ENABLER

-THE MODEL SERVES AS A CONCEPTUAL GUIDE OR COGNITIVE MAP FOR NURSES TO STUDY THE THEORY

C. KEYWORDS

CULTURE

- Norms and practices of a particular group that are learned and shared and guide thinking, decisions,
and actions.

CULTURAL VALUES

- The individual's desirable or preferred way of acting or knowing something that is sustained over a
period of time and which governs actions or decisions.

CULTURALLY DIVERSE NURSING CARE

- An optimal mode of health care delivery; it refers to the variability of nursing approaches needed to
provide culturally appropriate care that incorporates an individual’s cultural values, beliefs, and
practices including sensitivity to the environment from which the individual comes and to which the
individual may ultimately return.

↣Acculturation

• People of a minority group tend to assume the attitudes, values, beliefs, find practices of the dominant
society resulting in a blended cultural pattern.

C. KEYWORDS

Ethnocentrism

• The perception that one’s own way is best when viewing the world

Ethnic

• A term that relates to races or large groups of people classified according to common traits or customs

Race
• A term related to biology, since members of the same group share distinguishing physical features
such as skin colour, bone structure and blood group

Ethnography

- The study of culture

Culture shock

•A disorder that occurs in response to transition from one cultural setting to another

C. KEYWORDS

↣Religion

• It is a set of belief in a divine or super human power to be obeyed and worshipped as the creator and
ruler of the universe

↣Cultural identity

• The sense of being part of an ethnic group or culture↣

Material culture

• It refers to objects (dress, art, religious articles)

↣Non-material culture

• It refers to beliefs, customs, languages, and social institutions.

↣Diversity

• It refers to the fact or the state of being different. Diversity can occur between culture and within a
culture group

C. KEYWORDS

HISTORY OF TRANSCULTURAL NURSING

IN 1950’S MEDELEINE M. LEININGER, KNOWN AS THE FOUNDRESS OF TRANSCULTURAL NURSING,

NOTED CULTURAL DIFFERENCES BETWEEN PATIENTS AND NURSES WHILE WORKING WITH
EMOTIONALLY DISTURBED CHILDREN. THIS EXPERIENCE LED TO STUDY CLINICAL DIFFERENCE IN
PERCEPTION OF THE CARE. SHE RECOGNIZED THAT HEALTH AND ILLNESS STATES ARE STRONGLY
INFLUENCED BY CULTURE AND FORMULATED THE THEORY OF TRANSCULTURAL NURSING

IN 1991, SHE PUBLISHED ‘CULTURE CARE DIVERSITY AND UNIVERSALITY: A THEORY OF NURSING’

HER THEORY HAS NOW DEVELOPED INTO A DISCIPLINE IN NURSING. IN 1988 TRANSCULTURAL NURSING
SOCIETY INITIATED CERTIFICATION EXAMINATIONS: CERTIFIED TRANSCULTURAL NURSE (CTN)
IMPORTANCE OF TRANSCULTURAL NURSING

1) THERE IS A MARKED INCREASE IN THE MIGRATION OF PEOPLE WITHIN AND BETWEEN COUNTRIES
WORLD WIDE.

2) THERE HAS BEEN A RISE IN MULTICULTURAL IDENTIFIES, WITH PEOPLE EXPECTING THEIR CULTURAL
BELIEF, VALUES, AND LIFEWAYS TO BE UNDERSTOOD AND RESPECTED BY NURSES AND OTHER HEALTH
CARE PROVIDERS.

3) THE INCREASED USE OF HEALTH CARE TECHNOLOGY SOMETIMES CONFLICTS WITH CULTURAL
VALUES OF CLIENTS.

4) WORLD WIDE THERE ARE CULTURAL CONFLICTS, CLASHES, AND VIOLENCE THAT HAVE AN IMPACT
HEALTH CARE AS MORE CULTURES INTERACT WITH ONE ANOTHER.

5) THERE WAS AN INCREASE IN LEGAL SUITS RESULTING FROM CULTURAL CONFLICT, NEGLIGENCE,
IGNORANCE, AND IMPOSITION OF HEALTH CARE PRACTICES.

6) THERE IS AN INCREASE IN THE NUMBER OF PEOPLE TRAVELLING AND WORKING IN MANY DIFFERENT
PARTS OF THE WORLD.

7) THERE HAS BEEN A RISE IN FEMINISM AND GENDER ISSUES, WITH NEW DEMANDS ON HEALTH CARE
SYSTEMS TO MEET THE NEEDS OF WOMAN AND CHILDREN

8) THERE HAS BEEN AN INCREASED DEMAND FOR COMMUNITY AND CULTURE BASED HEALTH CARE
SERVICES N DIVERSE ENVIRONMENTAL CONTEXTS.

Madeleine Leininger's Culture Care Theory defines nursing as a learned scientific and humanistic
profession that focuses on human care phenomena and caring activities in order to help, support,
facilitate, or enable patients to maintain or regain health in culturally meaningful ways, or to help them
face handicaps or death.

CULTURE CARE THEORY

GENERIC (FOLK OR LAY) CARE SYSTEMS

Generic (folk or lay) care systems are culturally learned and transmitted, indigenous (or traditional), folk
(home-based) knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts
toward or for another individual, group, or institution with evident or anticipated needs to ameliorate or
improve a human life way, health condition (or well-being), or to deal with handicaps and death
situations.

LEININGER'S SUNRISE MODEL

The model shows factors

Technological

Kinship and social

Religious and philosophical

Cultural values and lifeways

Political and legal Economic and educational

They form sunrays that influence individuals, families and groups in health and illness

F. PURPOSE AND GOAL OF SUNRISE MODEL

PURPOSE AND GOAL

>To discover, document, interpret, explain and predict multiple factors influencing Care from a cultural
holistic perspective.

>The goal of the theory was to provide culturally congruent care that would contribute to the health and
well-being of people

SUNRISE MODEL

The model is based on the concept of culture care and shows 3 major nursing modalities that guide
nursing judgments and activities to provide 'Culturally Congruent Care’

3 major modalities are:

1) Cultural care preservation/ Maintainance

2) Cultural care Accommodation/Negotiation

3) Cultural care Repatterning /Reconstructing.

> CULTURE AND PRESERVATION AND MAINTENANCE

- Professional actions and decisions that help people of a particular culture to retain and/or preserve
relevant care values so that they can maintain their well-being, recover from illness, or face handicaps
and/or death

> CULTURE CARE ACCOMODATION OR NEGOTIATION

•Professional actions and decisions that help people of a designated culture to adapt to or to negotiate
with others for beneficial or satisfying health outcomes with professional care providers
> CULTURE CARE REPATTERNING ORRESTRUCTURING

Practices that are deleterious to overall health need to be restructured

> CULTURALLY CONGRUENT CARE

•It refers to those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that
are tailor made to fit the individual, group or institutional cultural values, beliefs and lifew ays in order
to provide or support meaningful beneficial and satisfying health care or well-being services.

C. WEAKNESS, STRENGTH AND KEY PROCESS OF THE THEORY STRENGTHS OF THEORY

>CULTURALLY COMPETANT CARE

>THE INDIVIDUAL CULTURAL PRIORITIES ARE RESPECTED

>MEANINGFULLY QUALITY OF CARE

>RESPECT FOR PATIENT-CULTURE AND THEIR VALUES

>FACILITATES THE NURSE-PATIENT RELATIONSHIP FOSTERING TRUST

C. WEAKNESS, STRENGTH AND KEY PROCESS OF THE THEORY

WEAKNESS OF THEORY

>TIME CONSUMING AND REQUIRES ONGOING RESEARCH

>MULTIPLE VARIATIONS WITHIN CULTURES SO THERE IS NOT AN INCLUSIVE AND AUTHORITATIVE WAY
TO DEFINE OR EXPLAIN A PARTICULAR CULTURE

>NOT USEFUL IN TIME OR TIME CONSTRAINT

G. ASSUMPTIONS AND OBSTACLE OF TRANSCULTURAL NURSING

ASSUMPTIONS ABOUT TRANSCULTURAL NURSING

> NURSING IS A TRANSCULTURAL PHENOMENON BECAUSE NURSING PRACTICES INVOLVE AT LEAST

TWO PERSONS, GENERALLY HAVING DIFFERENT CULTURAL ORIENTATION AND LIFE STYLES.

>CARING IS A UNIVERSAL PHENOMENON, HOWEVER,THE FORMS AND MANIFESTATIONS OF CARING

VARY AMONG CULTURES

G. ASSUMPTIONS AND OBSTACLE OF TRANSCULTURAL NURSING OBSTACLES IN TRANSCULTURAL

NURSING

> RELATED TO PROVIDERS ARISE

*NURSE BELIEF DIFFER FROM PATIENT BELIEF

> SYSTEM RELATED BARRIERS

* HOSPITAL FACILITIES HAVEN’T BEEN DESIGNED FOR CULTURAL DIVERSITY

Eg; ICUs

KEY CONCEPT OF THEORY

>CULTURAL DIVERSITY

>CULTURAL UNIVERSALITY

>GENERIC CARE

B. DR. LEININGER’S ASSESSMENT PROCESS

> NURSE APPROCHES AN INDIVIDUAL, FAMILY OR COMMUNITY WITH THE INTENT TO GAIN

UNDERSTANDING OF THE EXPRESSIONS, PATTERNS OF HEALTH AND CARE.

> NURSE TO OBTAIN KNOWLEDGE ABOUT THE DYNAMIC CULTURAL AND SOCIAL STRUCTURAL
DIMENSIONS INFLUENCING HEALTH.

> NURSE INVITES CARING INDIVIDUAL, FAMILY OR COMMUNITY TO DESCRIBE THEIR OWN EXPERIENCE
ABOUT HEALTH.

> NURSE DOCUMENTS THE DESCRIPTION OF AN INDIVIDUAL’S, FAMILY’S OR COMMUNITY’S CULTURAL

AND SOCIAL STRUCTURE THAT INFLUENCE HEALTH.

ROLE OF THE NURSE

>PROVIDE CARE THAT IS CONGRUENT WITH CULTURAL VALUES, BELIEFS AND PRACTICES

>PERFORM TRANSCULTURAL ASSESSMENT

>DEVELOP CULTURALLY COMPETENT INTERVENTIONS

> IN SERVICE STAFFS ON CULTURAL COMPETENCY

>INCLUDE TEACHING OF TRANSCULTURAL NURSING IN SCHOOL

CURRICULUM

TRANSCULTURAL SKILLS A NURSE NEEDTO REQUIRE:

THE NURSE WHO TAKES HER JOB SERIOUSLY AND STRIVES TO PROVIDE OPTIMAL NURSING, WILL FIND
THESE CONFLICTING CULTURAL ASPECTS INTERESTING AND CHALLENGING NOT ANNOYING!
CULTURAL COMPETENCE: THE UNDERSTANDING AND RESPECT OF THE NORMS, VALUES AND
CONVICTIONS OF PATIENTS.

THE NURSE SHOULD RESPECT AND ACCEPT THE VARIOUS CULTURAL BELIEFS AND CUSTOMS

- SHE SHOULD REALISE THAT ALL PEOPLE ARE NOT EXACTLY LIKE HERSELF

- SHE SHOULD THEREFORE BE SENSITIVE TO OTHER CULTURAL AND ETHNIC BACKGROUNDS

- TOTAL PATIENT CARE SHOULD TAKE PLACE

- PHYSICAL CARE IS IMPORTANT, BUT CULTURAL NEEDS SHOULD BE TAKEN INTO CONSIDERATION. IT
SHOULD BE KEPT IN MIND THAT EVERYONE, INSPITE OF DIFFERENCES ARE SPECIAL

- THE NURSE SHOULD NOTICE AND DEAL WITH CULTURAL DIFFERENCES WHICH MIGHT HAVE AN
IMPACT ON EFFECTIVE COMMUNICATION AND/OR NURSING CARE

- NURSING PROFESSIONALS SHOULD DEAL WITH CULTURAL DIFFERENCES WHICH MIGHT HAVE AN
IMPACT ON EFFECTIVE COMMUNICATION AND/OR NURSING CARE

- SHE SHOULD PROVIDE SENSITIVE ASSISTANCE TO PATIENTS WHO MAINTAIN NEGATIVE BELIEFS,
CUSTOMS AND BEHAVIOUR AND TRY TO GUIDE THEM TOWARDS POSITIVE HEALTH CARE

DECENT WORK AND EMPLOYMENT

DECENT WORK IN THE HEALTH SECTOR IS FUNDAMENTAL TO ENSURING EFFECTIVE AND RESILIENT
HEALTHCARE SYSTEMS AND POPULATION HEALTH AS A BASIS FOR INCLUSIVE

ECONOMIC GROWTH AND SUSTAINABLE DEVELOPMENT.

DECENT WORK IS PRODUCTIVE WORK FOR WOMEN AND MEN IN CONDITIONS OF FREEDOM, EQUALITY,
SECURITY AND HUMAN DIGNITY.

IT INVOLVES:

OPPORTUNITIES FOR WORK THAT IS PRODUCTIVE AND DELIVERS A FAIR INCOME,

SECURITY IN THE WORKPLACE AND SOCIAL PROTECTION FOR FAMILIES,

BETTER PROSPECTS FOR PERSONAL DEVELOPMENT AND SOCIAL INTEGRATION,

FREEDOM FOR PEOPLE TO EXPRESS THEIR CONCERNS,

ORGANIZE AND PARTICIPATE IN THE DECISIONS THAT AFFECT THEIR LIVES,

EQUALITY OF OPPORTUNITY AND TREATMENT FOR ALL WOMEN AND MEN

Communication

Culturally Competent nursing care

Cultural Competent in the health History and

Physical Examination

Transcultural Perspective in Childbearing

Transcultural Perspective in the Nursing care of

children, Adults and Older Adults

Transcultural Perspective in Mental Health Nursing

Transcultural Aspects of Pain

Culturally competent care includes knowledge, attitudes, and skills that support caring for people across
different languages and cultures

Becoming aware of how culture influences individual behavior and thinking allows you to plan the best
care for your patients.

Culturally competent care consists of five core building blocks.

CULTURAL AWARENESS involves examining yourself, dropping prejudices that you have previously
formed against foreign cultures, and developing the right attitude toward giving the best health service
to all patients and clients.

CULTURAL KNOWLEDGE involves searching for information about the culture and beliefs of your
patients to better understand and interact with them.

CULTURAL SKILLS involves your ability to collect relevant data and process it to help engage a patient in
meaningful cross-cultural interaction.

CULTURAL ENCOUNTER encourages nurses to venture out of the environment they are conversant with
and try new cultures and places. They improve their competence by interacting with people from
different backgrounds, cultures, and ethnicities.
CULTURAL DESIRE requires a strong motivation to learn more about other cultures. It is a strong force
that involves the ability to be open to new people, to accept and understand cultures that are different
from yours, and be willing to learn.

COMMUNICATION

TRANSCULTURAL VARIATIONS

Communication is the means by which culture is transmitted and preserved. Both verbal and nonverbal
communications are learned in one’s culture.

>Accurate diagnosis and treatment is impossible if the health-care professional cannot understand the
patient.

>Culture not only determines the appropriateness of the message but also influences all the
components of communication.

Even when nurses and patient’s speak the same language, miscommunication can occur because of
differences in values and beliefs.

Magnify this by the fact that the patient you are caring for has a cultural background that you are not
familiar with, and the potential for mis-communication grows even greater.

In addition to verbal communication, non-verbal cues that may represent different meanings can add to
the communication dilemma. The following are considerations to keep in mind when conversing with a
patient who is from a different culture then your own.

Conversational Style and Pacing - this includes tone of voice, uncomfortable periods of silences, saying
“No”, being blunt and to the point or taking a more indirect approach to communication.

Personal Space – people often assume that the personal space that is based on their own culture, is the
same space requirement of others. One example is that while one culture finds it respectful to square
off and face the person they are talking to, others find this very same trait to be aggressive in nature.

Eye Contact – as with personal space, eye contact is also another area of cultural competence that most
falter with. While some may view avoiding eye contact as respectful, others may view it as sneaky and
dishonest.

Touch – every culture has norms about how and when people should touch. Some cultures prohibit the
touch of specific body parts, such as one’s head or feet. Other cultures are more gender based in the
area of touch. As the primary care provider, the nurse must be aware of any specific rules the patient
may have about touch, prior to completing any type of physical assessment.
Time orientation – in some cultures, life is based around clock time, rather than personal or subjective
time. Being on time is very important to some people and in these cases, it is very important to keep the
appointments you make with these patients in order to maintain trust.

Communication Barriers

Natural Bias – Some things are noticed but others are not.

Generalizations – Comparing typical behavior patterns with what is actually being observed.

Negative Bias – Some views and strengths get left out.

Stereotypes – Seeing what is expected, and missing what is not expected.

When stereotypes are negative, prejudice moves in.

Prejudicial attitudes – Negative expectation, thoughts or emotions that ignore actual evidence.

Discriminatory Behaviors – Treating people unfairly: the “Ism’s.

Communication with American Indian patient’s

Major language and dialects – most American Indians speak English. Some often use anecdotes or
metaphors to discuss a situation.

Verbal discourse may be carefully constructed to provide precise meaning through examples.

Literacy assessment – If vocabulary is limited an interpreter may be needed.

Nonverbal communication – Respect communicated by avoiding eye contact and keeping a respectful
distance is recommended.

Greeting – Light touch or handshake. Do not refer to men as chiefs or women as squaws.

Tone of voice – Tone expresses urgency, when something is imperative be direct.

Communication with African American patient’s Major language and dialects – Most African Americans
speak English. Some use traditional dialects in the Carolinas, Alabama and Louisiana. Black English a very
expressive dialect is sometimes spoken in the inner cities. People may switch from Black English to
Standard English depending on the situation.

Literacy assessment – Refusal to sign documents or consent could indicate a literacy problem. Ask what
level of education the patient has completed.

Nonverbal communication – African Americans are affectionate people, they hug and show affection by
touching. Eye contact shows respect, and any overt silence on the part of the patient, may be a sign of
distrust for the caregiver. Greeting – African Americans prefer to be addressed as Mr., Mrs., or Miss.,
followed by their last name. A handshake is appropriate. Tone of voice – When speaking to each
other, conversation can get loud and animated. This may be the same if they are feeling anxious or
nervous.

Communication with Arab American patient’s

Major language and dialects – Arabic. Please note that

Egyptians also speak “Egyptian Arabic”. Different Arab countries and regions use different dialects that
give different words different meanings. Although their alphabet is very similar, Iranians and Arabs do
not understand each other’s language.

Literacy assessment – Arab professionals speak fluent English. Though some admit to speaking and
understanding English moderately, they may have difficulty understanding health professional’s
explanations and directions. Arabs tend to repeat things if they feel they are not being understood so
saying you understand and repeat what is being told to you will clarify this.

Nonverbal communication – Arab Americans are expressive, warm and other-oriented. They may at
times present with a flat affect to protect their true feelings. They are more comfortable with closeness
from the same sex. They are very polite and may not disagree openly with what is being asked of them.

Greeting – Greet using title and first name. Approach by shaking hands and acknowledging the country
of origin and something personal about the patient or family.

Tone of voice – Loud voice means message is important. Anger usually is expressed in a high intense
voice by patient or family members.

Communication with Chinese American patient’s

Major languages and dialects – Cantonese and Mandarin are the most common languages spoken.

Literacy assessment – The ability to speak and read varies from individual to individual. Elderly Chinese
(especially women) may not be able to read and write. Avoid yes and no questions and attempt to
ascertain whether true understanding is occurring or not.

Nonverbal communication – Eye contact and touching is noted between family members, but avoiding
eye contact with elderly patients is seen as a sign of respect. Keeping a respectful distance is also
recommended.

Greeting – Chinese people are often shy in an unfamiliar environment. Address elders with Mr./Mrs. and
their last name. Use of the first name when initial contact is made can be viewed as disrespectful.

Tone of voice – The Chinese language is very expressive and sometimes loud. Often this loudness is
interpreted as abrupt.

Communication with Filipino American patient’s

Major language and dialects – Filipino (Tagalog) is the national language. There are however more then
85 languages and dialects spoken. Most Filipinos do speak English as a second language.

Literacy assessments – Most Filipinos speak and understand English. Using simple medical terms will
assist them in understanding.

Non-verbal communication – Typically shy and affectionate. They are sometimes awkward in unfamiliar
surroundings and want family members to share their space for comfort and support.

Greeting – A smile or facial expression is frequently used as a greeting, a handshake is not commonly
practiced. Family members show elders respect by kissing their hand forehead or cheek.

Tone of voice – Filipino language as a practical language is not very rich. Changing the tone of their voice
is done often to evoke emotion and romanticize the language.

Communication with Korean American patient’s

Major language and dialects – older generations speak Korean, though younger generations most often
speak English.

Literacy assessment – Elders may have learned to understand English from younger generation, but still
may not be able to read or write English.

Understanding health care terminology may require an interpreter.

Nonverbal communication – When in the comfort of friends and family, touching and hugging is
acceptable. With strangers, touching is considered disrespectful except in the case of a physical
examination. Personal space is frequently shared with each other but not with strangers. Silence is
viewed as a tranquil, peaceful time that can be used for prayer and meditation. When conversing with
each other,

Korean’s are very excitable animated in communication.

Greeting – The use of Mr./Mrs./Miss and the last name unless the patient requests otherwise. Respect
towards elders and authority is constantly demonstrated.

Tone of voice – Tone has a wide variety of pitches with emphasized loudness depending on what the
speaker feels is important. Commands are given differently depends on whether they are intended for
an elder or a child.

Communication with Mexican American patient’s

Major language and dialects – Some speak Spanish exclusively but the majority are bilingual and speak
English as well. There are many indigenous languages in Mexico that give different meanings to different
words depending on the region that one lives.
Literacy assessment – There is a great diversity in educational levels. First generation females who do
not work outside of the home tend to be less likely to speak English. Younger Mexicans are more likely
to not only speak English, but also read and write English. It is important to assess reading/writing skills
and provide simple verbal and visual aids as appropriate.

Nonverbal communication – Respect strongly influences the use of nonverbal communication. Direct
eye contact is frequently avoided when one is considered an authority. Family members may stand
when someone enters the room as a form of respect. Silence sometimes shows a lack of agreement.
Touch by strangers can be perceived as disrespectful and can be very stressful.

Greeting – Using formal names is considered respectful.

Formal greetings should be used with elders and women. As time passes and increased comfort with
caregiver is perceived, a less formal greeting is required.

Tone of voice – A respectful and polite tone is usually used. Mexican American’s are very warm and
expressive. They can be noted to be reserved and quiet in an unfamiliar setting.

Communication with Vietnamese American patient’s

Language and dialects – The three major languages spoken by the Vietnamese are Vietnamese, French
and Chinese. Many have adopted English as their second language, but the ability to read/write English
must be assessed.

Literacy assessment – If patient is unable to read or write English there is usually a family member
present at all times who can assist them with this.

Nonverbal communication – A gentle touch may be appropriate when conversing with younger
generations, but with elders and more traditional Vietnamese people touching is limited. Avoiding eye
contact with those of higher standing shows respect. Slightly bowing head is a way to show respect.

Greeting – In a formal setting, the family name (which is the last name mentioned first) is the name of
choice. In a more casual setting, using the given or first name is acceptable. Vietnamese greet with smile
and bow rather than a handshake. Caregivers should not shake a woman’s hand unless she extends it
first.

Tone of voice – typically soft spoken. Raising the tone of voice and pointing a finger are a sign of great
disrespect. Indirectness and restraint rather that confrontation are the preferred method of
communication.

Expressions of pain

Pain, which is a universally recognized phenomenon, is a very important area for a nurse to consider
when taking care of multi-cultural patients. Being able to understand not only how pain is perceived, but
also how it is expressed will have a significant impact on the nursing interventions. In terms of pain
measurement, it is not only necessary to assess the pain threshold and individual tolerance, but also the
cultural norms and influence that surround the issue of pain. The following list discusses specific cultures
and how they perceive and express feelings of pain or discomfort.

American Indians – Pain is generally under treated with American Indians because in this culture is
usually not specific to what is hurting them. Often statements such as “I don’t feel well”, or “something
isn’t right” are expressions that will be used to describe pain.

American Indian patients may complain to a trusted family members about specific pain, so in when
assessing for pain, the nurse may find it beneficial to interview family members.

African Americans – Expressions of pain are generally open and public, but can as with all individuals
tend to vary in degree. Using a 1-10 pain scale with this group is most effective. Of important note, some
African Americans are hesitant to take pain medication for fear of becoming addicted. As the nurse it is
important to educate the patient to the addiction risks of pain medication when treating severe pain

Arab Americans – This cultural group is very vocal and expressive about pain, particularly if other family
members are present. Pain is feared and sometimes causes panic when it occurs. The goal for this group
is to do whatever is necessary to avoid pain altogether. If this cultura group understands the cause and
prognosis for the pain, they are much more likely to deal with it appropriately. As the nurse, when
dealing with African American patients who are suffering in pain, begin patient education regarding pain
as soon as possible.

Chinese Americans – This cultural group most likely will not complain of pain. It is important to be aware
of non-verbal cues when assessing for pain. Offering pain medication rather than waiting for the patient
to request it will assist with proper pain management. Acupuncture and acupressure are alternatives
that this group may use to control pain.

Filipino Americans – Stoic is the term that best describes this group when it comes to pain. As with the
Chinese Americans offering pain medication rather than waiting for the patient to request it will assist
with proper pain management. Some Filipino Americans have a high pain tolerance and this might also
be a reason why they do not request pain medication. “Moaning” is the most notable sign that pain is
being felt. This population prefers PO or IV routes of medication and are sometimes fearful of
medication that is given IM.

Korean Americans – “Ah-poom nida” means much pain and “chegesso” or “chegetta” are terms that
mean “I think I might die”. For the very stoic of this population, a pain scale may be not be tangible.
Instead ask “how bad is the pain” in order to get a better idea for treatment. For those who are more
dramatic in expressing pain, moaning and flailing around is not unusual. Fear of addiction and/or
complications makes pain management for this group sometimes difficult.

Mexican Americans – Verbalization of pain is not common but non-verbal cues are often used. For
some (especially men) showing outward signs of pain is viewed as being weak. In women expression of

pain is more acceptable. Using a pain scale is effective with this patient population.

Vietnamese Americans – “Dau” means pain in Vietnamese. This patient population tends to be stoic
about pain. Offering pain medication rather then waiting for the patient to request it will assist with
proper pain management. Some may understand a numerical pain scale if not, use facial expression of
pain and then ask “how severe is it”. Fear of addiction and/or complication with this patient population
as well can make pain management difficult.

Eye Contact: Native American, Southeast Asian, and Arab: view eye contact during conversation as
impolite or improper. Appalachians: Direct eye contract from strangers can be perceived as hostility or
aggression

Asian: Are reluctant to maintain eye contract with elders or superiors while they may expect their nurse
to be looking them in the eye because they view the nurse as a superior they may look at the ground or
hesitate before responding to questions. Eye contact can also be perceived as improper and impolite to
look someone in the eye during conversation. Muslim/Arab Women - may avoid eye contract with men
due to being modest.

Personal Space and Touch: Canadians, British, and Americans: Require several feet to maintain a
comfortable level of personal space. These groups of people require the largest personal space over
other cultures.

Middle East, Latin American and Japan: View larger personal spaces as a form of rejection or an insult.
Their personal space needs are much less.

Europeans: Often show a sign of affection by patting a child on the head.

Asian: Feel touching a child on the head is a show of disrespect and also believes that this can cause
illness. When dealing with an Asian family a safer approach to touching a child is to touch an upper
extremity while talking to assessing a child.

Mediterranean regions and Hispanic groups: Believe in frequent touch.

Middle Eastern Cultures: Do not believe in the touching of a male other than a women's husband is
unacceptable.

If you work in an area where you work with a high diversity of cultures it is essential that you do some
background work into someone's culture so that you are able to promote quality care without offending
your patient. By understanding ones cultural needs you are able to offer a more holistic approach to
your nursing care. Remember as a nurse you are responsible to become familiar with the cultures of
your area.
Terms & Definitions

Cultural Imposition - A situation where one culture forces their values and beliefs onto another culture
or subculture.

Cultural Importation - A situation where one culture buys or brings in products and goods from foreign
countries (cultures) to be used or sold in the importing culture.

Cultural Exportation - A situation where one culture sends products or goods to foreign countries
(cultures) to be used or sold in the exporting culture.

Belief Systems - A totality of enduring facts, principles and values that a person or a culture deems to be
true or to be trusted.

Norms - Standards that are accepted, often implicitly, by a culture.

Cultural Assessment

To complete a thorough cultural assessment on each patient that is admitted to the hospital is not only
time consuming, but also nearly an impossible feat given the short amount of time a nurse is allotted to
spend with each of her patients. Before you sit down to gather information from your patient, ask
yourself the following questions.

Awareness

Am I aware of my biases and prejudices towards other cultural groups, as well as racism in healthcare?

Skill- Do I have the skill of conducting a cultural assessment?

Knowledge- Am I aware about the worldviews of different cultural and ethnic groups, as well as have

knowledge in the field of bicultural ecology?

Encounters - Do I seek out face-to-face interactions with individuals who are different from myself?

Desire- Do I really "want to" become culturally competent?

Consider the case of an elderly Irish woman, who was hospitalized and then scheduled for surgery.

The woman complained of pain to her family but said nothing to her physician. Hiding pain is a general
characteristic of Irish women. Unaware of this cultural tendency, the physician denied the family’s
request to move up the surgery date. The woman’s condition worsened and she died during surgery.

If a culturally competent nurse had intervened, the Irish woman may have had an entirely different
outcome.

Another example is in Chinese culture, where a Chinese patient may be showing respect to a physician
by avoiding eye contact. In American culture, a lack of eye contact can be considered rude or an
indicator of depression. In both Muslim and Navajo cultures, eye contact has other distinct meanings.
Understanding the nuances between cultures and how language has different meanings for different
people is crucial when treating patients of

backgrounds different from one’s own.

As the bridge between practitioners and patients, nurses are in a unique position to respond to the

growing demand of a diverse population. If nurses can propel the healthcare industry toward

cultural competency, they can significantly reduce health disparity and ensure quality healthcare

for all populations.

Cultural Competent in the health History and Physical Examination

To perform a competent, relevant, and thorough assessment of a patient, cultural

issues must be taken into account.

The components of clinical assessment, including observation of the patient,

history-taking, physical examination, and laboratory testing, all may be influenced

by cultural factors. The cultural issues are most obvious if the patient

has a distinctly different background from the healthcare provider.

The patient may have very different beliefs and understanding of a particular

illness. Symptoms and complaints related to a given condition may be presented

very differently, and the patient’s attitude about being examined and tested may

vary substantially. If the patient speaks a different language from that of the

clinician, an

interpreter will be needed for translation.

This involves special considerations and skills on the part of both the interpreter

and the clinician

PRESENTATION OF PROBLEMS

IN A MANNER THAT CAN BE QUITE SUBTLE, A PATIENT’S STYLE OF PRESENTING COMPLAINTS IS

INFLUENCED BY CULTURAL FACTORS. IN GENERAL, HOW PRESENTING PROBLEMS AND THEIR

SYMPTOMS ARE DESCRIBED IS SUBJECT TO THE PATIENT’S EDUCATIONAL LEVEL, MEDICAL

KNOWLEDGE, AND MOTIVATION FOR TREATMENT, AS WELL AS THEIR CULTURALLY PATTERNED

MODES OF PROBLEM

WITH CULTURAL AND ETHNIC DIVERSITY COME MANY CHALLENGES. AS A HEALTH CARE

PROFESSIONAL, YOU ARE CHALLENGED WITH THE RESPONSIBILITY TO WORK WITH AND CARE

FOR INDIVIDUALS WHO MAY NOT HAVE THE SAME SKIN COLOR, LANGUAGE, HEALTH

PRACTICES, BELIEFS, AND VALUES AS YOUR OWN. WHEN THIS OCCURS, THE GOAL IS NOT TO

FORCE THE CLIENT AND HIS OR HER FAMILY TO COMPLY WITH YOUR BELIEFS, VALUES, AND

HEALTH PRACTICES BUT INSTEAD TO MEET THE CLIENT WHERE HE OR SHE IS AND TO WORK

WITH HIS OR HER BELIEF AND VALUE SYSTEM. THE CHALLENGE OCCURS NOT WHEN THE CLIENT

IS OF THE SAME HERITAGE AND SPEAKS THE SAME LANGUAGE AS THE NURSE, BUT WHEN THE

CULTURES AND LANGUAGES ARE DIFFERENT.

PURPOSE OF KNOWING THE PATIENT’S CULTURE

AND RELIGION FOR HEALTH CARE PERSONNEL

>Cultural background affects a person’s health in all dimensions, so the nurse should consider the
client’s cultural background when planning care.

>Although basic human needs are the same for all people, the way a person seeks to meet those needs
is influenced by culture.

>To foster understanding, respect and appreciation for the individuality and diversity of patient’s beliefs,
values, spirituality and culture regarding illness its meaning, cause, treatment and outcome

PURPOSE OF KNOWING THE PATIENT’S CULTURE

AND RELIGION FOR HEALTH CARE PERSONNEL

> To strengthen their commitment to relationship centered medicine that emphasizes care of the
suffering person rather than attention simply more to the pathophysiology of disease.

>To facilitate in recognizing the role of the hospital chaplain and the patient's clergy as partners in the
health care team in providing care for the patient.
>To encourage in developing and maintaining a program of physical, emotional and spiritual self-care
introduce therapies

A female nurse asks an Afghan woman about her reason for admission.
The nurse should expect?

The patient to speak in story rich context, rather than providing a brief
answer

When observing an Afghan American interact with other people, the

nurse recognizes that the use of touch is based on:
 How much they trust the person and amount of eye contact they
make
A nurse observes two Afghan women speak to each other in loud
voices. The nurse should:
 Recognize that high-volume is a way that females show affection in
public
Afghan and Afghan-Americans orientation of time is considered as:

All of the above

When a nurse is caring for an Afghan or Afghan-American, it is important to... SELECT ALL
THAT APPLY

B. Allow the patient to continue with their spiritual rituals, such as prayer 5 times daily.
C. Obtain a full patient history, paying careful attention to folk medicinal remedies used by the
patient.
D. Assess the patient for mental health issues such as depression and suicidal thoughts.

Afghan-Americans have a high risk for

developing... SELECT ALL THAT APPLY
A.Diabetes
B.Asthma
What barriers tend to keep African Americans from using healthcare
services? (select all that apply)
a. Poverty
b. Discrimination
c. Social barriers
d. Psychological barriers
e. Economic status
A Caucasian nurse is caring for a 27 year-old client and is becoming frustrated due to the
client pronouncing words incorrectly and not talking grammatically correct. What action
should the nurse take?

a. Understand that Black English is different than Standard English, try to understand
as much as possible

When working with an African American patient that is polychronic, what are
some important things to remember? (select all that apply)

a. They tend to collect activities

c. Very involved
d. Do not believe there is a specific order to getting things done

According to folk medicine, an African American pt. may consider

natural illness as resulting from which of the following? (select all that
apply)
a. Food
c. Water
d. Air
The time orientation of African American individuals
differs depending on personal experience
A nurse caring for a 1 day-old African American baby notices blue-green spots
on the infant's sacral area. What actions should the nurse perform? (select all
that apply)

b. Recognize the spots as Mongolian Spots

c. Document the findings in the infant's chart

What distinctions categorize the Appalachian region from the rest of

America? (select all that apply)
Poverty
Lack of Education
Lack of Urbanization

Which state is not part of the Appalachian region?

Kansas
While collecting data for an initial visit with an Eastern India Hindu American
couple, the nurse attempts to directly ask the wife about her health. The
women avoids eye contact and the husband becomes very defensive. Why
might this be?

The nurse asked the question to the wife

The nurse has an Eastern India Hindu American patient and has found it difficult to provide care
because the patient typically has 5-15 guests at a time and the room gets very crowded. What is the
best nursing intervention for this patient?

While providing care politely ask the guests to step out of the room except for father or husband

When communicating with an Eastern India Hindu American who

recently learned English as their second language, what nursing
interventions for this patient? Select all that apply.
Use gestures to communicate words
Use visual aids
Obtain a translator if necessary
Hindu culture includes many traditions. They typically inhabit a "beings-in-
becoming" mindset, and believe that present actions have large impacts on the
future. Because of this, the nurse should recognize that Hindus are.

All of the above

When getting report on a new Hindu patient, the nurse notes that he bathes daily due to his
religion. After breakfast, the nurse enters with bath supplies and tells the patient it is time to get
washed up. He refuses and asks her to return at a later time. What would be the nurse's best
response?

"We can reschedule for later today. What time would accommodate your needs?"

Which diseases might the nurse want to be hyper-aware of when

caring for a patient with Indian Hindu descent? Select all that apply.
G-6-PD deficiency
Thalassemia
Lactose intolerance
Stroke

What do Filipino Americans value most?

Family
A nurse is caring for a Filipino American patient and needs
to explain that the person's diagnosis is terminal. Who
should the nurse tell about the diagnosis first?
The family
 The nurse is caring for a Filipino American pt that is 6
months pregnant. What meal would the patient most likely
eat?
Soup and rice
Your patient is Filipino American and has hypertension and coronary
artery disease. Which food item that your patient picks shows they
understand the modifications to their condition?
White chicken breast with broccoli

You are discussing treatment plans with a Filipino American

Patient. What types of care are included in this culture?
What specific diseases are Filipino Americans susceptible to? SATA
A. Coronary artery disease
B. Hypertension
C. Diabetes

When speaking with Haitian-American clients, a nurse may want to

use which of the following communication techniques: (Select all that
apply)
A. Speak in direct language
B. Use many hand gestures
E. Use touch and eye contact
While working on a pediatric unit, a nurse has a Jewish patient that is 4 years old. She realizes that
the following is a normal practice in this culture:

Plan for someone to stay with the child at all times while he is in the hospital

A nurse is preparing to deliver a food tray to a Jewish client. The nurse checks
the food on the tray and notes that the client has received hamburger and whole
milk as a beverage. Which is the appropriate action for the nurse?

Call the dietary department ask for a new meal tray.

When gathering information from a Japanese American, it is important to do what?

Build a personal relationship

You are taking care of a Japanese American child with the mother in the room.
The mother begins aggressively coughing, but when asked if she is okay, she
replies that she's more concerned about her child's health. What should you do?
Remind her that her health is important too

Your Japanese American patient is at greater risk for which

of these conditions? Choose all that apply.
A. Glaucoma
B. HTN
C. Type 2 DM
D. Colorectal cancer
What do Japanese American believe cause disease or illness? Select
all that apply.
A. Contact with polluting agents such as blood, corpses, and skin
diseases
B. Disharmony with family or society
D. Imbalance such as a lack of sleep or exercise

When a Mexican American pt is admitted on your

floor, you should expect:
D. Friends and family of the patient
How should you greet someone who is Mexican-American?

Say hello

What should you do if your patient is embarrassed to be naked in front

of you? SATA
A. Assure them that you will only uncover what is necessary
C. Say it is normal to be embarrassed
D. Ask them how they would be comfortable
E. Make sure they have a nurse that is the same sex
In regards to death and dying, the Mexican American culture
believes that dying is a result of:
God's will
When scheduling an appointment for a Mexican American pt who is present oriented, you can
expect which of the following? SATA

A. They may be late to the appointment

C. They will need frequent reminders
D. They may need education on why follow up appointments are so important

In regards to social organization of the Mexican American Family,

which of the following is NOT true?
the elderly are primarily taken care of by members outside of the
family
A Mexican American Adolescent states to the nurse, "I have cancer because it is
God's will. It will make me stronger." The MOST appropriate response by the
nurse is:

 "Tell me how you feel about the treatment plan."

Mexican Americans tend to subscribe to which of the following beliefs?

A. Hot and cold/wet and dry

A nurse preparing patient teaching for hypertensive medication to a Nigerian man can expect
which of the following outcomes?

The client may be non-compliant in taking medications on time

A patterned behavioral response that develops

over a time as a result of imprinting the mind
through social and religious structures and
intellectual and artistic manifestations
Culture
is shaped by values, beliefs, norms and
practices
culture
When a patient does not follow medical advice
Nonadherance
What are the 6 cultural phenomena
communication, space, social organization,
time, environmental control and biological
variations
Culture is a _____________ process
Continuous
Adaption of care in a manner that is congruent
with the client's culture
cultural competence
A continuous process by which one person
may affect another through written or oral
language, gestures, facial expressions, body
language, space or other symbols
Communication
A nurse is caring for a Chinese client who is hospitalized due to pneumonia.
Based on their culture, which of the following is believed to be the cause of
the illness?

An illness may be attributed to overexertion

An American nurse tries to speak with a Korean client who cannot understand
the English language. To effectively communicate to a client with a different
language, which of the following should the nurse implement?

Have an interpreter to translate

A clinic nurse is preparing to examine a Hispanic child who was brought by

the mother for his first physical check-up. While assessing the child, the nurse
would avoid doing which of the following?

Admiring the child

A clinic nurse is performing an admission assessment for an African-

American client scheduled for an emergency appendectomy. Which of the
following questions would be inappropriate for the nurse to ask for the initial
evaluation?

How close is your family during these situations?

A nurse is caring a Native American client who experiences emotional distress
due to a family problem. In anticipating pharmacological treatment for the
client, the nurse understands that they would most likely:

Resort with the use of herbal medicines with healing properties.

A nurse is conducting an assessment of an American Indian woman who has

come to the clinic complaining of a headache. The patient tells the nurse that
the medicines prescribed by the tribal healer have done some good. What is
the appropriate response of the nurse at this time?

Tell me about these medicines and how often you are using them

A nurse is caring for a client who has symptoms of chills, fever, no sweating,
headache, nasal congestion, and stiffness and pain in the shoulders, upper
back, neck, and back of the head that are common in Chinese culture and is
called as syndromes of Wind. This is an example of which of the following?

Culture-bound syndrome

A Chinese-American client experiencing cough with clear white phlegm, which

is believed to be a yin disorder, is likely to treat it with:

Foods considered being yang

The ambulatory care nurse is discussing preoperative procedures with a

Japanese American client who is scheduled for surgery the following week.
During the discussion, the client continually smiles and nods the head. How
should the nurse interpret this nonverbal behavior?

Reflecting a cultural value.

The nurse is providing instructions to a Chinese-American client about the

frequency and dosages of the take home medicines. When conducting the
teaching, the client continuously turns away from the nurse. The nurse should
do which of the following appropriate action?
Continue with the instructions, then confirming client’s understanding

Which of the following food items would be appropriate for a Jewish client
who follows a kosher diet?

Tuna and salmon

A nurse is preparing to deliver a food tray to a Jewish client. The nurse checks

the food on the tray and notes that the client has received hamburger and
whole milk as a beverage. Which is the appropriate action for the nurse?

Call the dietary department and ask for a new meal tray

Which of the following clients has the lowest risk of diabetes mellitus and
stroke?

A 25-year-old Asian-American woman

The nurse identifies low-risk therapies to a client and should include which
therapy(s) in the discussion, except?

Acupuncture

A nurse is preparing a plan of care for a client who is a Jehovah’s Witness.

The client has been told that the surgery is necessary. The nurse considers
the client’s religious preferences in developing the plan of care and
documents that:

Blood products can not be administered

the main goal of transcultural nursing

to provide culturally specific care

norms and practices of a particular group that are learned and shared and
guide thinking, decisions, and actions

culture
the individual's desirable or preferred way of acting or knowing something that
is sustained over a period of time and which governs actions or decisions

The primary cross -cultural barrier in the case of nurse Rain is a problem due to

Challenges in communication

One example is that while one culture finds it respectful to square off and face the person they
are talking to, others find this very same trait to be aggressive in nature

PERSONAL SPACE

the culturally competent Nurse recognizes that the appropriate time for performing cultural
assessment is 

during each patient-nurse encounter

Speaking Loudly usually denotes  anger

False

Generic (folk or lay) care systems are culturally learned and transmitted, indigenous (or
traditional), folk (home-based) knowledge and skills used to provide assistive,
supportive, enabling, or facilitative acts toward or for another individual, group, or institution
with evident or anticipated needs to ameliorate or improve a human life way, health condition
(or well-being), or to deal with handicap

TRUE

ALL ARE TRUE ABOUT CULTURE AND PRESERVATION AND MAINTENANCE, EXCEPT;

Professional actions and decisions that help people of a designated culture to adapt  with others
for beneficial or satisfying health outcomes with professional care providers

Select the one False  statement on Culture is Learned 

It is integrated

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the
nurse demonstrating?

Stereotyping

Transcultural Nursing
All of the above
Touch is

all of the above

Select the one false statement about Generalization

None of the above

1. A nurse is assessing a 30-year old Chinese American client, what should the nurse be
particularly aware of? (Select all that apply)

A. Nonverbal behaviors of the client.

B. How the family is interacting with the client.
C. Encouraging the client to verbalize their psychological problems.

2. 2.According to the article on Communication and the older Chinese Americans that we
discussed earlier, which of the following is a true implication for nursing care of a
nurse caring for an older Chinese American client?

D. The nurse should avoid all eye-contact with the client.

3. What is an important question that the nurse can ask a Chinese American client
during their admission to the hospital?

c. "Are you comfortable communicating in this setting?"

4. A Chinese American client is experiencing a fever. The nurse recognizes that the client
is likely to self-treat the disorder, using which method?

D. Foods considered to be yang

5. In what probable way should a nurse expect a Chinese American client to view mental
illness?

A. Mental illness is related to uncontrolled behaviors that bring shame to the family.
6. Alternative modes of healing for Chinese Americans may include? (Select all that
apply.)
A. Acupuncture
C. Herbal Medicines
D. Moxibustion

7. Which of these are most valued in the Chinese American culture?

A. Family
C. Traditions
D. Male children

8. How do Chinese Americans perceive time?

D. Dynamic Wheel

9. True or false: Chinese American infants are more prone to jaundice.

False

10. A diet high in which of these foods will help lower incidence of diabetes and heart
disease in Native Americans?

A. Foods high in fiber, such as fruits and vegetables.

11. What type of food would an East Indian Hindu American NOT eat?

D. Chicken
12. Which of the following is the most important for the nurse to understand about East
Indian Hindu Americans?
 A. Right hand is used for eating, left hand is used for personal hygiene

13. The spokesman for the family to healthcare providers is __________.

B. Husband

14. A nurse walks into a patient's room and observes a couple communicating. The
husband is making direct eye contact with his wife. The wife would?

D. Keep eyes lowered, as a sign of respect

15. What do most East Indian Hindu Americans view as disrespectful in the eyes of the
gods?

B. Public display of affection

16. Often nicknamed the "3 troubles": pitta, ____, &____

B. Water: phlegm/kapha
D. Wind: vayu

17. When giving a bath what is considered acceptable?

C. adding hot water to cold water

18. When a loved one dies what does grieving look like? (SELECT ALL)

A. wailing
B. chanting
D. fainting

19. A nurse needs to interview an East Indian patient who only speaks Hindi. How should
the nurse interview the client?

A. Get a professional translator who speaks English and Hindi

20. 1) In a hospital waiting room, you notice two Afghan American women talking loudly
to one another. As a culturally competent nurse, you understand that the women are...
 C. Conveying their affection for one another.

21. Your Afghan American patient is crying in her hospital bed. As a culturally competent
nurse, you know the most appropriate action is to...

D. Sit beside your patient.

22. Your 28 year old female Afghan American patient just showed up to her appointment
with her husband and five young children. The most appropriate action is...

B. Ask the parents first, then offer the children coloring activities and/or toys to keep
them occupied during the exam.

23. Afghan Americans are known to be past, present, and future time oriented. Which is
an example of a present oriented Afghan American?

A. An Afghan American seen in social interaction activities.

24. An Afghan American patient walks into the hospital and is admitted with uncontrolled
diabetes. As a culturally aware nurse, you should know that...

B. The patient may have not known he had diabetes, so the nurse should ask and
advocate for the patient and their new diagnosis.

25. The following are examples of supernatural illness in and Afghan American culture...
(Select all that apply)

A. Jinns (attacked by a spirit or ghost)

B. Epilepsy
D. Evil eye (nazar)

26. Of the following which is true about the nursing care of a Korean American?

d. It is important to have proper posture and attentive listening skills

27. You are a nurse in the emergency department and your Korean American patient has
been given several options pertaining to the advancement of care, as a nurse you know
that it is important to:
 c. Educate patient and family on treatment options and understand that the patient's
superior may be the one to make the decision

28. When interacting with a Korean American it might be useful to understand that:

a. Korean Americans may stand closer than what is comfortable in lines at the
supermarket

29. When considering the dietary restrictions for many Korean-Americans, which of the
following should the nurse exclude?

c. Yogurt
\
30. When assessing a Korean American the nurse understands that one of the biggest
challenges to health care for these individuals is:

b. Lack of health care insurance

31. When planning appointments the nurse understands that many Korean Americans
have:

d. A future-oriented lifestyle, and will most likely be on time for their appointments
32. When giving care to an African American patient, which of the following is important
to keep in mind when performing interventions?

A. Polychronic

33. What is lacking for the African American patient which keeps him from seeking
immediate help from a physician? (select all that apply)

B. Socioeconomic status
C. Racism
D. Fear
34. Which of the following is a statement that an African American striving to be the
"perfect patient" might say?

d. My pain is a 0/10 today

35. You are taking care of an African American female who recently had a CVA, leaving
her unable to talk. As you attempt to give her medications with her milk on her tray,
she resists. After explaining the importance of taking her medications, and on time,
your client reluctantly takes the medications with milk. Later she has a large diarrhea
stool. What biological variation should have been considered with this patient?

A. Lactose intolerance is high among African Americans

36. Which health disease is NOT high in the African American population:

C. Osteoporosis

37. DeShawn is a 4 week old African American male who came in with flat, blueish-grey
like spots on his back. What would be an appropriate reaction?

D. Understand that they are Mongolian spots and are common in the African
American population
38. What languages do the Amish commonly use? (select all that apply)
A. English
C. Pennsylvania Dutch
D. German

39. TRUE or FALSE: During Church The men and women sit on opposite sides of the
church while children sit with the men

False

40. Why do the Amish not like higher education?

B. Fear of children leaving the church and joining the outside world

41. Which of the following is not true in relation to the Amish and environmental control?

B. The Amish have an internal locus of control

42. Which of these statements is true regarding the Amish and Nutrition?

D. They have large family gardens consisting of fruits and vegetables

43. The term Gelassenheit is an important part of Amish life. What does it mean?

A. Submission to the will of God

44. TRUE OR FALSE: blood transfusion, organ donation, cardiac bypass surgery, and
organ transplants are banned in the Amish culture

False

45. A nurse is caring for an 90 year old Amish man. What would you expect the family to
do?

C. sing to the patient

46. A nurse is educating a nursing student about diseases that the Amish population are
susceptible to. The nurse mentions all these diseases EXCEPT:

D. hypothyroidism
47. In what situation do you think an Amish person would refuse medical intervention?

A. heart transplant

48. Which of the following are true about Appalachian communication? (Select all that
apply)

A). Speak English

C). Straightforward with life
D). Will avoid confrontation by telling nurse what he/she wants to hear

49. All of the following statements about space are correct EXCEPT:

B). When a person is ill, the personal space remains and they want complete isolation

50. What are ways a nurse can improve communication with an Appalachian patient?
(Select all that apply)

A). Direct approach with the patient

B). Make the time to listen
D). Be straightforward and give the facts to the patient
51. The Appalachian people have a lower health status than the US average. Which of the
following are factors that contribute to their low status? (Select all that apply)

A. Low-paying jobs
B. Environmental toxins
 C. Lack of employment

52. 67% of rural areas in Appalachia are federally designated as shortage areas. Lack of
all of the following except contribute to this shortage?

D. Food

53. True or False: Lay practitioners or "granny women" are commonly used among the
Appalachian community.

False
54. A doctor's appointment is made for an Appalachian American, when should the nurse
expect the patient to arrive?

C. 15 minutes late

55. An Appalachian American patient is 30 minutes late to an appointment with a doctor,

as a nurse, what should the appropriate action be?

B. Still see the patient being sure to not turn them away.
.

56. What should a nurse consider about the family structure of an Appalachian American
when providing care? (Select all that apply)

A. Large numbers of family members will be present with patient.

E. Incorporate family members in health education

57. There is a Mexican American client that is being admitted to the hospital and the nurse
on duty has to perform the admission assessment. However, the client is unable to
understand English well. Which of the following should the nurse do in order to get
past the language barrier?

B. Get an approved interpreter.

58. A Mexican American client had a baby earlier this morning. The nurse enters the
room to congratulate the mother and admire the baby. How should the nurse do so in
order to remain culturally sensitive?
 C. Be sure to touch the baby while admiring the baby.

59. The nurse is preparing a plan of care for an elderly Mexican American patient that is
in poor health. Which of the following would be most appropriate?

D. Involve the family as much as possible in patient care.

60. Which is not a type of Jewish religion?

A. Orthodox
B. Conservative
D. Reform
61. A female Jewish American patient comes to the hospital because of her heart failure.
The patient requests a female nurse, but there are not any available female nurses.
What should the nurse do?

C. Explain to her that you respect her beliefs, but a female nurse is not available..
62. A nurse is caring for a Jewish American patient. The patient has a lot of family
members in the room. What is the best way for the nurse to teach her patient about her
condition?

.
D. Ask the family to quiet down, but include the entire family in the patient teaching.
.

63. A nurse is preparing to deliver a food tray to client whose religion is Jewish. The nurse
checks the food on the tray and notes that the client has received roast beef dinner with
whole milk as beverage. Which action will the nurse take?

B. call the dietary department and ask for new meal tray

64. A 52-year old Jewish lady had a right total knee arthroplasty this morning a Catholic
hospital. Crying hysterically, she rates her pain a 9 out of 10 every hour on the hour
despite receiving Hydrocodone Q4. The nurse becomes suspicious of potential drug
seeking behavior, how does the nurse handle the situation?

d. Acknowledge that the Jewish culture is emotional when expressing pain

65. At an assisted living community of Jewish clients, the public health nurse teaches about
diseases and disorders they're at higher risk of developing; SELECT ALL THAT
APPLY.

a. Hypercholesterolemia
c. Coronary disease
 d. Colorectal cancer

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only
Spanish and the nurse speaks only English. What is the appropriate nursing intervention?

Ask an interpreter for help

A nurse in an ambulatory care clinic is performing an admission assessment for an African-

American client scheduled for a cataract removal with an intraocular lens implant. Which
question would be inappropriate for the nurse to ask on an initial assessment:

"Do you have a close family relationship?"

Which of the following meal trays would be appropriate for the nurse to deliver to a client of
Jewish faith who follows a kosher diet?

Sweet and sour chicken with rice and vegetables, mixed fruit, juice

A Chinese-American client experiencing anemia, which is believed to be a yin disorder, is likely to treat it
with:

Foods considered to be yang

What is the nurse's response when a Hindu patient states, "The bath water is too hot."
Dump out water and restart the process

Which of the following factors contribute to a low rate of medical regimen compliance/adherence by
Mexican Americans?

Mexican Americans are present oriented

A 50-year-old Hispanic male with dark skin tone is on a Medical/Surgical Unit. He is presenting with
ashen colored areas of his skin, fatigue and weight loss. What is the most likely the cause?

Pernicious anemia

7. Which statement shows the student nurse understands Hindu cultural teaching:

b. "Hindus do not accept food from the left hand, as it is reserved for hygiene and toileting."

8. A Hindu patient states they sought their family healthcare decision maker. Who did they seek advice
from?

D. Mother in law

9.. What do Hindus view as disrespectful in the eyes of the gods?

D. PDA
10. When assessing a Hindu patient, what should the nurse be aware of?

D. Women stand more than arm's length from men

11. In regards to social organization, the nurse should be aware that traditional Amish culture consists
of:

a. A nuclear family
b. Women take care of children and husbands

d. main jobs are farming, carpentry, and woodworking

2. A nurse interviewing a female patient can identify that she has an external locus of control when she
says:

b. The body is a temple of God and will heal itself with His guidance

13. When learning about Amish American culture, it is important for the nurse to
remember that:

a. Most are bilingual

c. Nonverbal communication is very important to them

e. Children play a big role in the community

Which of the following would not be seen in a traditional Jewish diet?

 a. chicken, eggs, rice

15. T/F Birth control is an encouraged form of contraception in Amish communities

16. A Jewish-American patient arrives on the floor and is given a new diagnosis of cancer. What
response could the nurse expect from the patient in regard to their diagnosis?

c. I am going to start the new treatment the doctor recommended, and I know God will heal me, too

17. What is the best response of the nurse when she/he finds their Jewish American patient crying in
their room?

 Ask if they are experiencing any pain

What are the best ways to reduce anxiety in a Jewish-American patient? SATA.

a. Involve family and close friends

d. Explain why they are getting certain medications and treatments

Why might a well-educated, relatively wealthy Afghan-American find getting a job difficult? SATA

a. Discrimination due to being a Muslim and of a different nationality

b. Lack of experience perceived as relevant by employers

e. Lack of familiarity with American job interview expectations

 A 27-year-old Afghan female presents to your healthcare facility with a suspicious lump in the upper left
breast. She is very nervous about being touched by a male healthcare worker and insists she will leave if
she is not examined by a female, but there are no female doctors available. Her husband has
accompanied her. What is the FIRST thing you do?
 b. Ask the husband if he is comfortable with a male examiner as long as he is present in the room

 T/F In the Afghan-American culture, keeping appointments and being on time is more important than
family obligations or social interactions, some often forgoing hospitality to uphold previous
responsibilities.

22. It is traditional for immediate family members to do what, following the passing of a family
member? (Select all that apply)

B. Mourn for a full year

C. Abstain from attending joyful events such as weddings and birthdays for a full year

23. Which of these are true regarding Afghan health care? (Select all that apply)

c. Afghans are likely to seek out western medicine

d. Afghans tend to lack health care

24. When planning care for a Chinese American patient which action made by the nurse is best in
regards to family involvement?

c. Incorporate tasks for the family members to do to help care for the patient

25. When Chinese Americans communicate they generally prefer to be:

d. Sitting side-by-side the person they are talking to

26. Which of the following best describe characteristics of Chinese American families? (Select all that
apply)

a. Hierarchical structure

c. Tradition and loyalty to the family are strongly valued

d. The main authority figure has the power in decision making

27. Which of the following best describes the time a Chinese American patient shows up to an
appointment time?

a. The patient showed up on time.

28. All of the following are true regarding Chinese Americans' belief in Qi except:

b. Individuals can change their environment.

29. Which of the following medications should be monitored closely with a Chinese American patient?
(Select all that apply).

a. Haldol
c. Valium
e. Inderal
Which of the following diseases are Mexican Americans at risk for?

 a. Diabetes mellitus

b. Hypertension
d. HIV/AIDS

31. Which of the following factors contribute to a low rate of medical regimen
compliance/adherence by Mexican Americans?

b. Mexican Americans are present oriented

32.A 50-year-old Hispanic male with dark skin tone is on a Medical/Surgical Unit. He is
presenting with ashen colored areas of his skin, fatigue and weight loss. What is the most likely
the cause?

a. Pernicious anemia

33. When caring for a Mexican American patient, the nurse should be careful to AVOID which of the
following...

c. Continuously making jokes throughout the assessment

34. When it comes to space within the Mexican American culture, which of the following statements is
FALSE?

c. They are comfortable being close to anyone - not just family and friends

35. A male nurse is about to perform an assessment on a young female client who is of Mexican
American descent and is noticing that she is not making eye contact and it turning away from him. What
is an appropriate intervention for the male nurse to take in this situation?

a. Acknowledge that she may be uncomfortable, and ask a female nurse to take over

6. With the knowledge that African Americans are present-oriented, which of the following
interventions would the nurse need to implement? (Select all that apply)

A.Emphasize importance of follow-up visits

C.Focus on preventative measures

D.Aid in making a medication schedule

How should a nurse go about education and developing a plan of care for an African-American patient?

B. Include both patient and family in planning and education

38 What are some factors that could influence the seeking medical care for African-Americans?

39. Which of the following are biological variations that are specific to African-Americans? (Select all
that apply)

A. Increased risk for developing hypertension

D. Increased bone density

40. Which of the following is true regarding traditional West African beliefs on environmental control?

C. Illness is caused by a spiritual conflict or sin

41. T/F The Appalachian Americans only care about the communities' well-being.

42. Which of the following are factors of Appalachian Americans having a lower health status than the
national average? SATA.

a.Lower-Paying Jobs

c.Environmental toxins
d.Lack of employment

e.Noise

43.Of the following, which are nursing implications that should be exercised regarding the Appalachian
American Folk health care system? Select all that apply.
a. Explore any herbal therapies in depth in relation to current clinical situation

c. Nurses should provide health information to patient when herbal remedies or OTC medications
prove harmful
d. The central nursing role is to aid the client to find appropriate level of health information

44. A nurse is developing a plan of care for an African American patient with hypertension. While
reviewing the doctor's orders, which course of treatment should be recognized as the most effective?

D. Administering a calcium channel blocker

45. SATA: Which of the following are Jewish sectors in the US?

a. Orthodox
b. Conservative
c. Reform
d. Reconstructionist

1.A nurse is assessing a 30-year old Chinese American client, what should the nurse be particularly
aware of? (Select all that apply)

A. Nonverbal behaviors of the client.

B. How the family is interacting with the client.

C. Encouraging the client to verbalize their psychological problems.

D. The length of their hair.

A. Nonverbal behaviors of the client

C. Encouraging the client to verbalize their psychological problems

Rationale: Monitor the nonverbal behaviors of the client and encourage the client to verbalize their
psychological problems as they may be less likely to verbalize these on their own.

2. 2.According to the article on Communication and the older Chinese Americans that we discussed
earlier, which of the following is a true implication for nursing care of a nurse caring for an older Chinese
American client?

A. The nurse should speak loudly and animatedly toward the client.

B. The nurse should address both spoken and written healthcare communication needs of the client.

C. The nurse should address the client only when the client has first spoken to the nurse.

D. The nurse should avoid all eye-contact with the client.

B. The nurse should address both spoken and written healthcare communication needs of the client.

Rationale: AEB the article previously discussed, we learned that when communicating with elderly
Chinese Americans, it is important for the nurse to provide written and spoken means of communication
to the patient to most positively effect their health status and level of care

3. What is an important question that the nurse can ask a Chinese American client during their
admission to the hospital?

a. "Where is your family?"

b. "What are you wearing?"

c. "Are you comfortable communicating in this setting?"

d. "How did you get here?"

c. "Are you comfortable communicating in this setting?"

Rationale: Chinese Americans may be less likely to communicate feelings of discomfort so it is important
to address the client's personal space and recognize the need to adjust this space according to the
client's voiced feelings and observed nonverbal behaviors.

4. A Chinese American client is experiencing a fever. The nurse recognizes that the client is likely to self-
treat the disorder, using which method?

A. Prayer

B. Magnetic therapy

C. Foods considered to be yin

D. Foods considered to be yang

C. Foods considered to be yin

5. In what probable way should a nurse expect a Chinese American client to view mental illness?
A. Mental illness is related to uncontrolled behaviors that bring shame to the family.

B. Mental illness is a curse from God related to immoral behaviors.

C. Mental illness is cured by home remedies based on superstitions.

D. Mental illness is cured by "hot and cold" herbal remedies.

A. Mental illness is related to uncontrolled behaviors that bring shame to the family

6. Alternative modes of healing for Chinese Americans may include? (Select all that apply.)

A. Acupuncture

B. Opioids

C. Herbal Medicines

D. Moxibustion

Acupuncture

C. Herbal Medicines

D. Moxibustion
7. Which of these are most valued in the Chinese American culture?

A. Family

B. Pets

C. Traditions

D. Male children

E. Female children

A. Family

C. Traditions

D. Male children

8. How do Chinese Americans perceive time?

A. Past

B. Present

C. Future

D. Dynamic wheel
Dynamic wheel

9. True or false: Chinese American infants are more prone to jaundice.

True

10. A diet high in which of these foods will help lower incidence of diabetes and heart disease in Native
Americans?

A. Foods high in fiber, such as fruits and vegetables.

B. Cheap, processed, snack foods and meals that do not require much effort to prepare.

C. Any foods as long as there is high alcohol consumption with meals.

D. Traditionally prepared foods like frybread.

A. Foods high in fiber, such as fruits and vegetables.

11. What type of food would an East Indian Hindu American NOT eat?
A. Rice

B. Beans

C. Bread

D. Chicken

D. Chicken

12. Which of the following is the most important for the nurse to understand about East Indian Hindu
Americans?

A. Right hand is used for eating, left hand is used for personal hygiene

B. Left hand is used for eating, right hand is used for personal hygiene

C. Either hand can be used for eating

D. A person must use chopsticks and not eat finger food

A. Right hand is used for eating, left hand is used for personal hygiene

13. The spokesman for the family to healthcare providers is __________.

A. Son

B. Husband

C. Grandfather
D. Wife

B. Husband

14. A nurse walks into a patient's room and observes a couple communicating. The husband is making
direct eye contact with his wife. The wife would?

A. Make direct eye contact also

B. Walk out of the room

C. Become very verbal with the husband

D. Keep eyes lowered, as a sign of respect

D. Keep eyes lowered, as a sign of respect

15. What do most East Indian Hindu Americans view as disrespectful in the eyes of the gods?

A. Eating meat

B. Public display of affection

C. Dancing

D. Men talking loud

B. Public display of affection

16. Often nicknamed the "3 troubles": pitta, ____, &____

A. Earth: bones & muscle

B. Water: phlegm/kapha

C. Space: hollow organs

D. Wind: vayu

B. Water: phlegm/kapha

D. Wind: vayu

17. When giving a bath what is considered acceptable?

A. adding cold water to hot water

B. bathing after breakfast

C. adding hot water to cold water

D. not bathing at all

C. Adding hot water to cold water

18. When a loved one dies what does grieving look like? (SELECT ALL)

A. wailing

B. chanting

C. showing no emotions

D. fainting

A. wailing

B. chanting
D. fainting

19. A nurse needs to interview an East Indian patient who only speaks Hindi. How should the nurse
interview the client?

A. Get a professional translator who speaks English and Hindi

B. Ask a family member to translate.

C. Use the computer to translate

D. Don't worry about the family will figure it out.

A. Get a professional translator who speaks English and Hindi

20. 1) In a hospital waiting room, you notice two Afghan American women talking loudly to one another.
As a culturally competent nurse, you understand that the women are...

A. Trying to speak over their husbands.

B. Arguing with one another.

C. Conveying their affection for one another.

D. Trying to stand out from the crowd.

C. Conveying their affection for one another.

21. Your Afghan American patient is crying in her hospital bed. As a culturally competent nurse, you
know the most appropriate action is to...

A. Give your patient a hug.

B. Call an interpreter to help you figure out why she is crying.

C. Sit beside your patient and hold her hand.

D. Sit beside your patient.

D. Sit beside your patient.

22. Your 28 year old female Afghan American patient just showed up to her appointment with her
husband and five young children. The most appropriate action is...

A. Ask her husband to wait in the lobby with the children.

B. Ask the parents first, then offer the children coloring activities and/or toys to keep them occupied
during the exam.

C. Tell her not to bring her children to her next appointment.

D. Give the children a snack of pork rinds and apple juice.

B. Ask the parents first, then offer the children coloring activities and/or toys to keep them occupied
during the exam.

23. Afghan Americans are known to be past, present, and future time oriented. Which is an example of a
present oriented Afghan American?

A. An Afghan American seen in social interaction activities.

B. An Afghan American worried about holding up traditions.

C. An Afghan American who is a really hard worker.

D. An Afghan American who is worried about their child's education.

A. An Afghan American seen in social interaction activities.

24. An Afghan American patient walks into the hospital and is admitted with uncontrolled diabetes. As a
culturally aware nurse, you should know that...

A. The patient should have controlled this issue.

B. The patient may have not known he had diabetes, so the nurse should ask and advocate for the
patient and their new diagnosis.

C. Categorize this illness as supernatural jinns.

D. This illness is common in Afghan Americans since their diet is poor and consists of food with high
sugar portions.

B. The patient may have not known he had diabetes, so the nurse should ask and advocate for the
patient and their new diagnosis.

25. The following are examples of supernatural illness in and Afghan American culture... (Select all that
apply)

A. Jinns (attacked by a spirit or ghost)

B. Epilepsy

C. Illness because it is the Will of God

D. Evil eye (nazar)

E. Illness that arises after not being clean.

A. Jinns (attacked by a spirit or ghost)

B. Epilepsy

D. Evil eye (nazar)

26. Of the following which is true about the nursing care of a Korean American?
a. Korean Americans do not speak English, therefore you will always need a translator

b. Korean Americans do not mind crowds or physical touch

c. When presenting yourself in conversation with a Korean American you should speak slow and loudly.

d. It is important to have proper posture and attentive listening skills

d. It is important to have proper posture and attentive listening skills

27. You are a nurse in the emergency department and your Korean American patient has been given
several options pertaining to the advancement of care, as a nurse you know that it is important to:

a. Educate the patient on their condition and their treatment options and allow them to have a quiet
alone space to meditate and decide on further treatment

b. Allow the patient to communicate with family and collectively decide what is best

c. Educate patient and family on treatment options and understand that the patient's superior may be
the one to make the decision

d. Allow the physician to answer any questions and collect the patient's preference for advancing care

c. Educate patient and family on treatment options and understand that the patient's superior may be
the one to make the decision

28. When interacting with a Korean American it might be useful to understand that:

a. Korean Americans may stand closer than what is comfortable in lines at the supermarket

b. Korean Americans avoid eye contact during conversation to show that they are shy and might not
respond as a sign of respect

c. When sitting next a Korean American you should cross your legs at the knee with the sole of your foot
exposed
d. Koreans are present oriented, so they might be late to dinner plans

a. Korean Americans may stand closer than what is comfortable in lines at the supermarket

29. When considering the dietary restrictions for many Korean-Americans, which of the following should
the nurse exclude?

a. Chicken

b. Gluten

c. Yogurt

d. Peanuts

c. Yogurt

30. When assessing a Korean American the nurse understands that one of the biggest challenges to
health care for these individuals is:

a. Resentment toward healthcare workers

b. Lack of health care insurance

c. Proximity to hospitals and clinics

d. Present-oriented lifestyle

b. Lack of health care insurance

31. When planning appointments the nurse understands that many Korean Americans have:
a.An internal locus of control, and will most likely show up for appointments

b.A present-oriented lifestyle, and will often be late for appointments.

c. A polychromic lifestyle, and will most likely be distracted during appointments.

d. A future-oriented lifestyle, and will most likely be on time for their appointments

d. A future-oriented lifestyle, and will most likely be on time for their appointments

32. When giving care to an African American patient, which of the following is important to keep in mind
when performing interventions?

A. Polychronic

B. Monochronic

C. Polymorphic

D. Monomorphic

A. Polychronic - pts may need to multitask and have multiple events occuring in the space

33. What is lacking for the African American patient which keeps him from seeking immediate help from
a physician? (select all that apply)

A. transportation

B. Socioeconomic status

C. Racism

D. Fear

B. Socioeconomic status
C. Racism

D. Fear

34. Which of the following is a statement that an African American striving to be the "perfect patient"
might say?

a. Can I have some more medication

b. I need help getting to the bathroom

c. I noticed the IV wiring is kinked

d. My pain is a 0/10 today

d. My pain is a 0/10 today

35. You are taking care of an African American female who recently had a CVA, leaving her unable to
talk. As you attempt to give her medications with her milk on her tray, she resists. After explaining the
importance of taking her medications, and on time, your client reluctantly takes the medications with
milk. Later she has a large diarrhea stool. What biological variation should have been considered with
this patient?

A. Lactose intolerance is high among African Americans

B. Hypertension is high among African Americans

C. Tuberculosis is high among African Americans

D. Dietary variations may cause diarrhea in African Americans

A. Lactose intolerance is high among African Americans

36. Which health disease is NOT high in the African American population:
A. Diabetes

B. Sickle cell anemia

C. Osteoporosis

D. Hypertension

C. Osteoporosis

37. DeShawn is a 4 week old African American male who came in with flat, blueish-grey like spots on his
back. What would be an appropriate reaction?

A. Tell the mom she is an unfit mother and take the baby away

B. Call child protective services so they can take the baby away

C. Look the other way and sympathize with the mom because you understand infants are a handful and
it is only a couple bruises after all

D. Understand that they are Mongolian spots and are common in the African American population

D. Understand that they are Mongolian spots and are common in the African American population

38. What languages do the Amish commonly use? (select all that apply)

A. English

B. Spanish

C. Pennsylvania Dutch

D. German

E. French
A. English

C. Pennsylvania Dutch

D. German

39. TRUE or FALSE: During Church The men and women sit on opposite sides of the church while
children sit with the men

False

40. Why do the Amish not like higher education?

A. They do not have enough teachers

B. Fear of children leaving the church and joining the outside world

C. Too many chores to do

D. They are not smart enough

B. Fear of children leaving the church and joining the outside world

41. Which of the following is not true in relation to the Amish and environmental control?

A. The Amish have an external locus of control

B. The Amish have an internal locus of control

C. The Amish believe that everything is God's will

D. The Amish view their bodies as temples of God

B. The Amish have an internal locus of control

42. Which of these statements is true regarding the Amish and Nutrition?

A. The men help the wives prepare meals

B. They do not eat at public restaurants

C. Their diet consists largely of red meats

D. They have large family gardens consisting of fruits and vegetables

D. They have large family gardens consisting of fruits and vegetables

43. The term Gelassenheit is an important part of Amish life. What does it mean?

A. Submission to the will of God

B. Submission to the word of God

C. Praying to God

D. Obeying God

A. Submission to the will of God

44. TRUE OR FALSE: blood transfusion, organ donation, cardiac bypass surgery, and organ transplants
are banned in the Amish culture

False

45. A nurse is caring for an 90 year old Amish man. What would you expect the family to do?
A. read to the patient

B. request a roommate for the patient

C. sing to the patient

D. ask for pain meds for the patient

C. sing to the patient

46. A nurse is educating a nursing student about diseases that the Amish population are susceptible to.
The nurse mentions all these diseases EXCEPT:

A. Type 2 DM

B. maple syrup urine disease

C. Hypertension

D. hypothyroidism

D. hypothyroidism

47. In what situation do you think an Amish person would refuse medical intervention?

A. heart transplant

B. kidney transplant

C. blood donation

D. child birth

A. heart transplant
48. Which of the following are true about Appalachian communication? (Select all that apply)

A). Speak English

B). Consider eye contact to be a sign of respect and should always be used

C). Straightforward with life

D). Will avoid confrontation by telling nurse what he/she wants to hear

A). Speak English

C). Straightforward with life

D). Will avoid confrontation by telling nurse what he/she wants to hear

49. All of the following statements about space are correct EXCEPT:

A). High importance of personal space

B). When a person is ill, the personal space remains and they want complete isolation

C). Close family involvement when someone is ill

D). Appreciative of privacy

B). When a person is ill, the personal space remains and they want complete isolation

50. What are ways a nurse can improve communication with an Appalachian patient? (Select all that
apply)

A). Direct approach with the patient

B). Make the time to listen

C). Only consider the patient's views, not family's opinion

D). Be straightforward and give the facts to the patient

A). Direct approach with the patient

B). Make the time to listen

D). Be straightforward and give the facts to the patient

51. The Appalachian people have a lower health status than the US average. Which of the following are
factors that contribute to their low status? (Select all that apply)

A. Low-paying jobs

B. Environmental toxins

C. Lack of employment

D. High availability of health screenings

E. Desire for preventative measures

A. Low-paying jobs

B. Environmental toxins

C. Lack of employment

52. 67% of rural areas in Appalachia are federally designated as shortage areas. Lack of all of the
following except contribute to this shortage?

A. Transportation

B. Insurance

C. Telephones

D. Food
E. Available resources

D. Food

53. True or False: Lay practitioners or "granny women" are commonly used among the Appalachian
community.

True

False

False

54. A doctor's appointment is made for an Appalachian American, when should the nurse expect the
patient to arrive?

A. 15 minutes early

B. On time

C. 15 minutes late

D. Never

C. 15 minutes late

55. An Appalachian American patient is 30 minutes late to an appointment with a doctor, as a nurse,
what should the appropriate action be?

A. Ask the patient to reschedule to a later date.

B. Still see the patient being sure to not turn them away.
C. Turn the patient away stating that the doctor does not have enough time to see them.

D. Recommend the patient to be on time for the next visit.

B. Still see the patient being sure to not turn them away.

56. What should a nurse consider about the family structure of an Appalachian American when
providing care? (Select all that apply)

A. Large numbers of family members will be present with patient.

B. Need to consult mother in regard to health care decisions.

C. Ask any family members to leave room because of patients need for personal space while ill.

D. Provide lots of natural lighting to lift mood.

E. Incorporate family members in health education

A. Large numbers of family members will be present with patient.

E. Incorporate family members in health education

57. There is a Mexican American client that is being admitted to the hospital and the nurse on duty has
to perform the admission assessment. However, the client is unable to understand English well. Which
of the following should the nurse do in order to get past the language barrier?

A. Try to continue and communicate with the patient.

B. Get an approved interpreter.

C. Have another nurse help that knows some Spanish.

D. Have a family member translate.

B. Get an approved interpreter.

58. A Mexican American client had a baby earlier this morning. The nurse enters the room to
congratulate the mother and admire the baby. How should the nurse do so in order to remain culturally
sensitive?

A. Just admire the baby but be sure not to touch the baby.

B. Only the parents are allowed to look at or touch the baby.

C. Be sure to touch the baby while admiring the baby.

D. The nurse should bless the baby before touching it.

C. Be sure to touch the baby while admiring the baby.

59. The nurse is preparing a plan of care for an elderly Mexican American patient that is in poor health.
Which of the following would be most appropriate?

A. Arrange home hospice care for the patient.

B. Recommend placing the patient in the nursing home.

C. Plan for a long term stay in the hospital.

D. Involve the family as much as possible in patient care.

D. Involve the family as much as possible in patient care.

60. Which is not a type of Jewish religion?

A. Orthodox

B. Conservative

C. Deconstructivist
D. Reform

C. Deconstructivist

61. A female Jewish American patient comes to the hospital because of her heart failure. The patient
requests a female nurse, but there are not any available female nurses. What should the nurse do?

A. Ignore them and give her a male nurse.

B. Tell her that she will not be able to be cared for at that hospital.

C. Explain to her that you respect her beliefs, but a female nurse is not available.

D. Tell a female nurse she has no option but to care for this patient.

C. Explain to her that you respect her beliefs, but a female nurse is not available.

62. A nurse is caring for a Jewish American patient. The patient has a lot of family members in the room.
What is the best way for the nurse to teach her patient about her condition?

A. Tell the family to leave so that she can clearly explain the situation to the patient.

B. Shout the information so that the patient can hear over her family members' voices.

C. Come back later.

D. Ask the family to quiet down, but include the entire family in the patient teaching.

D. Ask the family to quiet down, but include the entire family in the patient teaching.

63. A nurse is preparing to deliver a food tray to client whose religion is Jewish. The nurse checks the
food on the tray and notes that the client has received roast beef dinner with whole milk as beverage.
Which action will the nurse take?
A. deliver the food tray to the client

A nurse is preparing to deliver a food tray to client whose religion is Jewish. The nurse checks the food
on the tray and notes that the client has received roast beef dinner with whole milk as beverage. Which
action will the nurse take?

A. deliver the food tray to the client

B. call the dietary department and ask for new meal tray

C. replace the whole milk with fat-free milk

D. ask the dietary department to replace the roast beef with pork

B. call the dietary department and ask for new meal tray

64. A 52-year old Jewish lady had a right total knee arthroplasty this morning a Catholic hospital. Crying
hysterically, she rates her pain a 9 out of 10 every hour on the hour despite receiving Hydrocodone Q4.
The nurse becomes suspicious of potential drug seeking behavior, how does the nurse handle the
situation?

a. Withhold Hydrocodone at next dose so the patient won't become addicted

b. Be aware when a person of the Jewish culture is ill they regress to childish behaviors

c. Explain to the patient that she is an adult, therefore she needs to act like one

d. Acknowledge that the Jewish culture is emotional when expressing pain

d. Acknowledge that the Jewish culture is emotional when expressing pain

65. At an assisted living community of Jewish clients, the public health nurse teaches about diseases and
disorders they're at higher risk of developing; SELECT ALL THAT APPLY.
a. Hypercholesterolemia

b. Grave's disease

c. Coronary disease

d. Colorectal cancer

e. Hemophilia

A. Hypercholesterolemia

c. Coronary disease

d. Colorectal cancer

66. The ambulatory care nurse is discussing preoperative procedures with a Japanese American client
who is scheduled for surgery the following week. During the discussion, the client continually smiles and
nods the head. How should the nurse interpret this nonverbal behavior?

1. Reflecting cultural value

2. An acceptance of treatment

3. Client agreement to the required procedures

4. Client understanding of the preoperative procedures

67. The nurse educator is providing in-service education to the nursing staff regarding transcultural
nursing care; a staff member asks the nurse educator to describe the concept of acculturation. The
nurse educator should make which most appropriate response?

1. "It is a process of learning a different culture to adapt a new or changing environment."

2. "It is a subjective perspective of the person's heritage and a sense of belonging to a group."

3. "It is a group of individuals in a society who are culturally distinct and have a unique identity."
4. "It is a group that shares some of the characteristics of the larger population group of which it is a
part."

68. The nurse is providing discharge instructions to a Chinese American client regarding prescribed
dietary modifications. During the teaching session, the client continuously turns away from the nurse.
The client should implement which best action.

1. Continue with instructions, verifying client understanding.

2. Walk around the client so that the nurse constantly faces the client.

3. Give the client a dietary booklet and return later to continue with instructions.

4. Tell the client about the importance of the instructions for the maintenance of health care.

69. The nurse identifies low-risk therapies to a client and should include which therapy(s) in the
discussion? Select all that apply.

1. Herbs

2. Prayer

3. Touch

4. Massage

5. Relaxation

6. Acupuncture

70. Which client(s) has a high risk of obesity and diabetes mellitus? Select all that apply.

1. A 40-year-old Latino American man.

2. A 45-year old Native American woman.

3. A 23-year-old Asian American woman.

4. A 35-year-old Hispanic American woman.

5. A 40-year-old African American woman.

71. The nurse is preparing a plan of care for a client who is a Jehovah's Witness. The client has been told
the surgery is necessary. The nurse considers the client's religious preferences in developing the plan of
care and should document which information?

1. The client believes the soul lives on after death.

2. Medication administration is not allowed.

3. Surgery is prohibited in this religious group.

4. The administration of blood and blood products is not allowed.

72. The role of the nurse regarding complementary and alternative medicine should include which
action?

1. Advising the client about "good" versus "bad" therapies

2. Recommending herbal remedies that the client should use

3. Discouraging the client from using any alternative therapies

4. Educating the client about therapies that he or she is using or is interested in using

73. An antihypertensive medication has been prescribed for a client with hypertension. The client tells
the clinic nurse that they would like to take an herbal substance to help lower their blood pressure. The
nurse should take which action?

1. Tell the client herbal substances are not safe and should never be used.

2. Teach the client how to take their blood pressure so that is can be monitored closely.

3. Encourage the client to discuss the use of an herbal substance with the health care provider.

4. Tell the client that if they take the herbal substance they will need to have their blood pressure
checked frequently.

74. Nurse is caring for a Muslim patient and knows that individuals of this religion pray several times a
day. Which intervention is most appropriate in caring for this patient?

1. Schedule patient care around these prayer times.

2. Encourage the patient to plan prayers around treatments

3. Activities take precedence over religious beliefs.

4. If the patient is praying, interrupt for care and allow him or her to finish later.

75. A female Muslim patient has been assigned to a male nurse. As the nurse enters the room, the
patient becomes very upset. The nurse understands this patient is upset because of what component of
this patient's religious beliefs?

1. She does not think she is ill.

2. Her husband is not present.

3. She prefers to be taken care of by a female.

4. She cannot speak English.

76. Which nursing diagnosis is appropriate for a 35-year-old Hispanic patient who does not speak
English?

1. Deficient knowledge

2. Noncompliance

3. Impaired verbal communication

4. Ineffective coping

77. The nurse is doing discharge teaching with an African American patient regarding nutrition intake.
What food customs should the nurse consider when developing this educational plan?

1. Raw fish is the main component of the diet.

2. Many meats and vegetables are fried in lard.

3. Red meat is the primary source of protein in the diet.

4. Rice is eaten with all meals.

78. What percentage of Americans speak a language other than English at home?

a. one in five
b. one in 10

c. one in 15

d. one in 20

79. According to research, the large majority of Americans are:

a. catholic

b. protestants

c. muslims

d. christians

80. Ideally, the nurse selects a spiritual advisor for the patient based on:

a. the nurse's knowledge of the patient's religion

b. the patient's expressed desire

c. the availability of a spiritual advisor within the healthcare system

d. the family's wishes

81. when caring for the patient who is muslim, which statement indicates an important cultural nursing
consideration? (select all that apply)

a. the nurse assists the patient with ambulation after surgery

b. the nurse frequently offers clean water to ensure patient's cleanliness

c. the nurse reheats the patient's food to ensure that it stays warm

d. the nurse provides quiet and private time for meditation and prayer

82. the nurse considers the care needs of a person who uses a wheelchair. when planning care, the
nurse recognizes that the best approach is to (select all that apply):

a. plan activities that will maintain the patient's immobility and limit the patient's safety risks
b. encourage the patient to move freely and to have the most autonomy that the clinical situation
allows

c. encourage activities that force the patient develop stronger motor skills

d. sit facing the patient to maintain eye-to-eye contact

83. the culturally competent nurse recognizes that the use of certain language can be demoralizing to
persons with disabilities. which of these statements suggest that the nurse is using culturally
appropriate language when caring for clients with disabilities?

a. the nurse giving a report at change of shift mentions act the patient is afflicted with mobility problems
and has recently been stricken with MS

b. the emergency room triage explains that, "since your are handicapped, I'll place you in a larger cubicle
for your assessment"

c. the nurse explains to the doctor, "I believe this young lady may've a hearing impairment."

d. a nurse exclaims, "I was just assigned to a. mental retarded patient".

84. the nurse admits Mr. Smith, a member of the Cherokee Tribe, to the unit. When preparing to
conduct the initial nursing interview and assessment, the nurse considers that Mr. Smith's cultural
heritage suggests that his language is most likely to be:

a. low context

b. high context

c. nonverbal

d. midcontext

85. When the nurse plans cross-linguistic care for her newly admitted patient, she is most concerned by
patient behaviors that suggest differences in:

a. linguistic style

b. language context

c. literacy

d. cultural attitudes
 NCM 121
DECENT WORK
EMPLOYMENT AND
TRANSCULTURAL
NURSING
COACH MELODY LABOG
 MODULE 6:

FUTURISTIC NURSING

LEARNING OUTCOME:

IMPLEMENT APPROPRIATE TECHNOLOGY IN PROVIDING

CLIENT- CENTERED COMPETENT CARE TO CLIENT FROM
VARIOUS CULTURAL BACKGROUND
 MODULE 6:
FUTURISTIC NURSING

OBJECTIVES:
1. DESCRIBE VARIOUS FUTURE DEVELOPMENTS IN NURSING PRACTICE
2. EXPLAIN VARIOUS STRATEGIES FOR FUTURE NURSING
3. DISCUSS ABOUT CURRENT VISIBILITY OF NURSING
4. EXPLAIN THE FACTORS AFFECTING VISIBILITY OF NURSING
5. DESCRIBE THE STEPS TO INCREASE THE VISIBILITY OF NURSING
FUTURSTIC NURSING INTRODUCTION:
IT IS TIME FOR NURSING TO QUESTION AND REDEFINE ITS ROLE WITHIN SYSTEM AND TAKE
STEPS TO BRING ABOUT THE FUTURE THAT THE NURSING PROFESSION IS TO ACHIEVE.

MODERN NURSING DEFINITION:- “THE ART OF USING THE LATEST TECHNOLOGY

& SCIENCE TO PROMOTE QUALITY OF LIFE AS DEFINED BY PATIENTS AND FAMILIES
THROUGH OUT THEIR LIFE EXPERIENCES FROM BIRTH TO THE END OF LIFE.”
 MODULE 6:
FUTURISTIC NURSING
FUTURSTIC MEANING (INNOVATIVE/REVOLUTIONARY) INNOVATION IS THE ACTION OF
INTRODUCING A NEW METHOD , IDEA OR PRODUCT.

A. ASPECTS OF FUTURISTIC NURSING

□NURSING EDUCATION □NURSING SERVICES NURSING
EDUCATION FUTURE ISSUES:
• MULTIPLE SETTINGS
• CRITICAL THINKING
• REQUIRE EXTENSIVE KNOWLEDGE
• MORE COMPLEX SPECIALIZED PRACTICE CAUSES OF
CHANGES IN NURSING EDUCATION
□CHANGING DEMOGRAPHICS
□TECHNOLOGICAL EXPLOSION
□GLOBALIZATION
□CHANGING ERA
□SHIFT TO POPULATION BASED CARE & INCREASING COMPLEXITY OF PATIENT CARE
B. NURSING CHALLENGES AND OPPORTUNITIES

>SOCIETAL CHALLENGES

>DEMOGRAPHIC CHALLENGES

>ENVIRONMENTAL CHALLENGES

>LIFESTYLE CHALLENGES

>COST CONTROL CHALLENGES

>REGULATION CHALLENGES
C. TECHNOLOGICAL ADVANCEMENT

>TECHNOLOGY CHANGED NURSING

>TELEMEDICINE

>TELEHEALTH NURSING

>IMPACT ON TELEHEALTH ON PATIENT OUTCOME

>ROBOT NURSING

>FUTURISTIC CYBER NURSING

C. TECHNOLOGICAL ADVANCEMENT
The explosive growth of technology will continue to have
an impact on healthcare delivery.
The growth of this technology will change the way nurses
function, and lead to the development of new nursing roles.
Electronic medical records are expected to replace
conventional modes of documentation.
The promotion of advanced directives, organ donation, and
comfort measures for the terminally ill will lead to elevation
in hospice care providers.
Care modalities which include pain management, spirituality
assessment and bereavement counseling will be incorporated
into health care organizations and nursing education curriculums.
Nursing research will greatly contribute in developing
and implementing these therapy options.
Work Environments
Nursing's dissatisfaction with the workplace environment is
another issue that must be faced when considering the
profession's future.
This dissatisfaction was multifaceted and included issues such
as workplace violence, inability to attend continuing
education
programs due to heavy workloads, exhaustion, and inability to
provide safe patient care.
Mee and Robinson (2003) state that "nurses need work
environments with strong professional practice models that value
their work and recognize their impact on patient outcomes.
Globalization
Factors contributing to globalization include advances in
information technology and communications, international travel
and commerce, the growth
of multinational corporations.
Future nurses will face the challenge of maintaining holistic
approach to client care in an environment of growing
specialization.
Focus on health promotion, maintenance, and revitalization
will continue to grow.
D. TRENDS OF FUTURISTIC NURSING

SERVICE(PRACTICE)

*CLINICAL NURSE SPECIALIST

*ADULT NURSE PRACTITIONER
*FAMILY NURSE PRACTITIONER
*GERIATRIC CARE PRACTITIONER
*PEDIATRIC NURSE PRACTITIONER
*CERTIFIED NURSE MIDWIFE(CAM)
* CERTIFIED NURSE ANESTHETIST(CAN)
*WOMEN HEALTH NURSE PRACTITIONER
NURSING SERVICES • BY THE YEAR 2020- LESS THAN 15 YEARS FROM NOW A STUDY FROM OCCUPATIONAL
HEALTH AND SAFETY ADMINISTRATION PREDICT THAT THE NEED FOR • REGISTERED NURSES IN NURSING
HOMES WILL INCREASE -66% • LICENSED PRACTICAL AND VOCATIONAL NURSES-72% • CERTIFIED NURSING
ASSISTANTS-69% • NURSES WORK IN HOME SETTING-250%

NURSING SHORTAGE IN FUTURE • ACCORDING TO DR.PETER BUERHAUS IN AUSTRELIA • SHORTAGE OF RN’S BY 2025 BE
AS HIGH AS 500000 • DEMAND OF RN’S IS EXPECTED TO GROW BY 2% OR 3% EACH YEAR

EFFECTS OF NURSING SHORTAGE IN FUTURE

□ HOSPITALS WILL BE RESERVED ONLY FOR SICKEST
□ NURSES WILL DO MUCH MORE POPULATION BASED OR COMMUNITY HEALTH CARE
□INCREASE NURSES’ PATIENT’S LOADS
□INCREASES THE RISK FOR ERROR
□INCREASE RISK OF SPREADING INFECTION TO PATIENTS AND STAFFS
• INCREASE RISK FOR OCCUPATIONAL INJURY
• INCREASED DEATHS
• INCREASE IN NURSING TURNOVER
• INCREASE PERCEPTION OF UNSAFE WORKING CONDITIONS,
• INCREASED STRESS
TELEMEDICINE • IS DEFINED AS "THE REMOVAL OF TIME AND DISTANCE BARRIERS FOR THE DELIVERY OF
HEALTH CARE SERVICES AND RELATED HEALTH CARE ACTIVITIES THROUGH TELECOMMUNICATION
TECHNOLOGY".

IMPACT OF TELEHEALTH NURSING • TELEHEALTH IS DIRECT COMMUNICATION BETWEEN THE PATIENT AND THE
PROVIDER
• IT INTEGRATES INFORMATION AND TECHNOLOGY TO FACILITATE HEALTH CARE DELIVERY.
• TELEHEALTH REMOVES TIME AND DISTANCE BARRIERS VIA VIDEOPHONES, VIDEO CAMERA.
• THE TELEHEALTH CONTRIBUTES TO POSITIVE OUTCOMES IN TERMS OF SELF MANAGEMENT AND COMPLIANCE.
ROBOT NURSING
ROBOT-NURSE HELPS NURSES IN HOSPITALS.
□ HER BODY IS DEVELOPED BY SAMSUNG
□ HER BRAIN BY ROBOT-HOSTING.COM.
□ THE UNIVERSITY OF AUCKLAND ARE CREATING HER NURSE KNOWLEDGE BASE. □ SHE HAS FACE
RECOGNITION (CAMERA), VOICE RECOGNITION (MICROPHONE), ARMS AND HANDS ROBOT NURSING •TALKS
(SPEAKER) WITH THE PATIENTS, DOCTORS AND NURSES IN 8 HUMAN
LANGUAGES. • ANOTHER RESPONSIBILITY IS TALKING WITH THOSE PATIENTS WHO DO NOT HAVE ANY VISITOR.
THEREFORE THEY WILL NOT FEEL LONELY