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Chapter 5: Cultural Competence
6 problems · 0 figuresCase Study 5.1.1 §5.1 source ↗
Refer back to Chapter 2 Communication for Unfolding Case Study Parts 1-3 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old female patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son.
| Past Medical History | Patient is a mother of one, who cares for her child and older mother in a small apartment. The patient’s mother is not able to leave home and is not present at the hospital. Patient engages in house cleaning to financially support her family; however, the income is inconsistent. Patient has an eighth-grade education, is a native Spanish speaker, and does not speak English. Medical history includes seasonal allergies, sinusitis, and two episodes of COVID-19 in the past two years. Family history: Patient’s father is deceased, and patient’s mother has stage 2 Alzheimer disease. Patient’s son is in good health, talkative, and attentive to his mother. Social history: Patient is primary caregiver for mother and adolescent. No other support systems available. Patient has difficulty shopping and making doctor’s appointments due to lack of care for her mother. Patient has difficulty communicating in English, so the son translates for his mother. No current medications and no known allergies. |
| Nursing Notes | 2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports that patient was seen at the clinic for a cough and was diagnosed with pneumonia and started on medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress. |
| Flow Chart | 2310: Assessment Blood pressure: 135/75 mm Hg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear) |
| Lab Results | None |
| Diagnostic Tests/Imaging Results | Chest x-ray: Bilateral infiltrates indicative of pneumonia. Sputum culture pending. |
| Provider’s Orders | 2330: New orders Close observation. Continue antibiotics. Wean off oxygen as tolerated. |
1. patient does not speak English
2. oxygen saturation 97 percent
3. heart rate 97 beats/minute
4. sputum culture results
Answer
A. Rationale: The patient appears to be stable currently. The nurse should recognize the need for an interpreter as the priority to improve communication because the patient does not speak English.
Case Study 5.1.2 §5.1 source ↗
Refer back to Chapter 2 Communication for Unfolding Case Study Parts 1-3 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old female patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son.
| Past Medical History | Patient is a mother of one, who cares for her child and older mother in a small apartment. The patient’s mother is not able to leave home and is not present at the hospital. Patient engages in house cleaning to financially support her family; however, the income is inconsistent. Patient has an eighth-grade education, is a native Spanish speaker, and does not speak English. Medical history includes seasonal allergies, sinusitis, and two episodes of COVID-19 in the past two years. Family history: Patient’s father is deceased, and patient’s mother has stage 2 Alzheimer disease. Patient’s son is in good health, talkative, and attentive to his mother. Social history: Patient is primary caregiver for mother and adolescent. No other support systems available. Patient has difficulty shopping and making doctor’s appointments due to lack of care for her mother. Patient has difficulty communicating in English, so the son translates for his mother. No current medications and no known allergies. |
| Nursing Notes | 2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports that patient was seen at the clinic for a cough and was diagnosed with pneumonia and started on medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress. |
| Flow Chart | 2310: Assessment Blood pressure: 135/75 mm Hg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear) |
| Lab Results | None |
| Diagnostic Tests/Imaging Results | Chest x-ray: Bilateral infiltrates indicative of pneumonia. Sputum culture pending. |
| Provider’s Orders | 2330: New orders Close observation. Continue antibiotics. Wean off oxygen as tolerated. |
1. The patient is lying about their pain level.
2. The patient’s pain has improved since getting to the hospital.
3. The patient’s culture may dictate how they show and process pain.
4. The son stated the patient’s pain was a 9/10 so she would get pain medicine more quickly.
Answer
C. Rationale: Pain is whatever the patient says it is. In this case, it is likely that the patient’s culture processes pain and the meaning of pain differently than what the nurse expects to see. In some cultures, it is common to remain stoic, regardless of how severe the pain is. This highlights the importance of obtaining a thorough history and assessment so that cues are not missed.
Case Study 5.1.3 §5.1 source ↗
Refer back to Unfolding Case Study #1: Part 4 to review the patient data.
| Nursing Notes | 0100: Assessment Patient given one dose of acetaminophen and reports that ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside. |
Answer
Health disparities are health outcomes that are worse in certain populations. The social determinants of health are external factors such as the neighborhood people live in or access to health care and have a direct impact on health disparities. In this particular case, the patient reports that income is inconsistent, likely classifying the patient as from a low socioeconomic status, which is a social determinant of health. Having a limited (or inconsistent) amount of income directly impacts the patient’s ability to provide for her family and obtain healthcare services, both of which contribute to the development of health disparities.
Case Study 5.1.4 §5.1 source ↗
Refer back to Unfolding Case Study #1: Part 4 to review the patient data.
| Nursing Notes | 0100: Assessment Patient given one dose of acetaminophen and reports that ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside. |
Answer
First, the nurse should attempt to obtain more information about the patient’s situation. This needs to be done with care as this can be sensitive to talk about. In this case, the nurse also needs to request assistance from the interpreter because the patient does not speak English. Once more information about the patient’s finance and home situation obtained, the nurse can initiate appropriate referrals. Often this includes a referral to a social worker or counselor who can assist the patient in finding community and other resources to address economic or social needs.
Case Study 5.3.5 §5.3 source ↗
Refer back to Unfolding Case Study #1: Part 4 to review the patient data.
| Nursing Notes | 0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications. |
| Flow Chart | 0700: Assessment Blood pressure: 128/72 mm Hg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air |
| Provider’s Orders | 0745: New orders Discharge after meeting with social worker. |
Answer
First, the nurse will determine what the patient considers to be the problem and what they call it. In this case, the nurse may ask the patient, “What do you call your illness?” or “What does your illness mean to you?” Second, the nurse should ask the patient what they think caused the illness. In some cultures, it is believed that illness is caused by imbalances in the body or is a punishment from God. The nurse should accept the patient’s answer without judgment, even if it does not align with the nurse’s personal beliefs. Next, the nurse should ask what the patient is doing to cope with the problem. The nurse should take note of any cultural differences in the way the patient handles the illness, such as use of folk remedies or nontraditional healers, which could impact the patient’s care plan. Last, the nurse will ask the patient how concerned they are about the illness. Some cultures view illness as “God’s will” and are not concerned, while others express more concern. In this case, specifically, the nurse may also want to ask how concerned the patient is about their finances and access to health care as it has been determined that the SDOH are likely impacting the patient’s overall health.
Case Study 5.3.6 §5.3 source ↗
Refer back to Unfolding Case Study #1: Part 4 to review the patient data.
| Nursing Notes | 0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications. |
| Flow Chart | 0700: Assessment Blood pressure: 128/72 mm Hg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air |
| Provider’s Orders | 0745: New orders Discharge after meeting with social worker. |
Answer
Many times, nurses provide patients with resources and referrals while in the hospital but then have no idea if they followed through and got the assistance they needed. To combat this, the nurse can do a few different things. First, the nurse should work closely with the social worker to ensure that appropriate resources are available and that the patient’s contact information is provided and all follow-ups are scheduled. This helps ensure that contact with the patient is not lost after discharge. Additionally, the nurse should continuously assess the patient’s social needs while they are in the hospital, initiating appropriate referrals as needed. In many cases, nurses and patients build a rapport during the hospital stay which allows the patient to confide in the nurse and allows the nurse to assist the patient with resources. The nurse can ask the patient questions such as “Did I address all of your concerns?” or “Is there anything you are worried about that we haven’t talked about yet?” to determine whether the patient’s social needs have been completely addressed.
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Problems and answers are adapted from Fundamentals of Nursing by Christy Bowen, Lindsay Draper and Heather Moore, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/fundamentals-nursing/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.