Question 1

A terminally ill patient from a different culture tells the nurse that she cannot decide what to do until her brother arrives since he is the major decision maker for the family. Which of the following should the nurse do first?

Accepted Answer

The patient is from a culture in which a male member of the family makes decisions regarding healthcare. The first thing that the nurse should do is to wait for the brother to arrive and, with the patient, discuss the decisions made regarding her care. It would not be appropriate at this time for the nurse to request an assignment change. It is also too soon for the nurse to contact the hospital's attorney to be present when the brother arrives. It would be inappropriate to tell the patient that in the United States, she makes the decisions, regardless of her culture of origin.

Question 2

A terminally ill patient tells the nurse that he is not ready to die because there are many people that he needs to ask for forgiveness. Which of the following can the nurse do to help this patient?

Accepted Answer

The nurse needs to assist the patient to work through his needs for forgiveness. This is the most important intervention to help the patient find peace and restoration at this time. The nurse should offer to work with the patient in contacting the individuals that the patient wants to talk with. She should not suggest that the patient ask each individual mentally for forgiveness, or remind him that God forgives everyone. Telling the patient to focus on improving his health and not death is not supporting the patient's spiritual needs at this time.

Question 3

The nurse is admitting a patient who is from her same culture. Although the nurse can communicate somewhat with the patient in her native language, she would not be able to conduct a thorough assessment without difficulty. Which of the following should the nurse do?

Accepted Answer

A nurse who is able to speak a few words of the patient's language is greatly appreciated. Even a rudimentary knowledge of the language conveys the message that the nurse values the people being served and wants to communicate with them. Unless the nurse is fluent in the language, however, an expert interpreter should be sought. Often a family member is selected to be the interpreter. This must be evaluated on a case-by-case basis. It must be verified that the family member is fluent in English and that the interpretation is not delivering a distorted message to the patient. Family members sometimes want to withhold negative findings in an attempt to protect the patient. The nurse should explain that an interpreter is going to be obtained, and should not conduct the assessment process without one. The nurse should not ask if the daughter can interpret nor ask the patient for someone else to interpret.

Question 4

A patient from another culture is being visited by a friend who is fluent in English as well as the language of cultural origin. The nurse needs to talk with the patient about starting chemotherapy and the friend volunteers to interpret. Which of the following should the nurse do?

Accepted Answer

If a friend or family member is asked to interpret, there must be adequate documentation that the patient has agreed to this arrangement. Such documentation alleviates any concerns about divulging confidential health information regarding the patient. The nurse should find out if the patient wants the friend to be an interpreter before telling the friend what the patient needs to know. The nurse should not just explain what is going to be done so that the friend can give the patient an overview. The nurse should not explain to the patient what is going to be done, without assistance from an interpreter

Question 5

A terminally ill patient tells the nurse that his priest is coming to anoint him with oil to aid in the healing process and requests that no one come into the room during this time. Which of the following should the nurse do?

Accepted Answer

Allowing for privacy to practice rituals must be evaluated on a case-by-case basis. The patient and family may or may not want the nurse to be involved with traditional practices. While provision of privacy is important, the nurse must be sure that attempts to provide privacy are not interpreted as attempts to isolate patient or family. She should assure the patient that he and the priest will not be disturbed during the anointing process. Telling him that there is no way that his request can be met would be inappropriate. Reminding the patient that he is in the hospital and people will come and go in the room as necessary is also inappropriate. Suggesting that the priest arrive during evening hours would be unrealistic.

Question 6

The nurse is answering the questions on the SPIRIT assessment before using it to assess the patient's spiritual needs. Which of the following explains why the nurse is doing this?

Accepted Answer

Before using any of the spiritual assessment tools available, the nurse should conduct a self-assessment in order to improve individual spiritual self-awareness. The nurse is not practicing using the tool or making sure that no question is missed. The nurse is also not preparing answers for questions that the patient might have difficulty with.

Question 7

The nurse is planning to conduct a spiritual assessment with a patient diagnosed with cancer. Which of the following should the nurse do first before conducting this assessment?

Accepted Answer

Before conducting the assessment with any tool, the nurse should conduct a self-assessment to help facilitate understanding of the patient's responses. The nurse does not need to contact a member of the clergy to be in attendance during the assessment or provide the assessment tool to the patient to read and review before discussing the responses. Asking the patient if he has any spiritual needs to determine if the assessment needs to be done is inappropriate.

Question 8

The nurse, caring for a terminally ill patient, is having difficulty with the patient's belief in God and faith for healing. Which of the following can the nurse do to support this patient's spiritual beliefs?

Accepted Answer

Nurses seeking to provide spiritual intervention for others should spend time defining their own spirituality. Becoming comfortable with one's own spirituality is the first step towards increased sensitivity to spiritual issues in others. The nurse should not contact a member of the clergy to talk with the patient or tell the patient that medical care, not faith in God, is what will heal the patient. The nurse should not assume that the patient is in denial and do nothing.

Question 9

The nurse, preparing to administer chemotherapy to a terminally ill patient, sees that the patient is sitting quietly in the room reading the Bible. Which of the following should the nurse do at this time?

Accepted Answer

To support this patient's spiritual needs, the nurse needs to respect that the patient is reading the Bible at the time of desiring to administer chemotherapy. The best approach would be to return later to administer the medication. The nurse should not interrupt the patient and administer the medication while the patient is reading, or announce that it is time for medication and ask that the reading be done later. The nurse should not sit down in the room and watch the patient read since this would violate the patient's private spiritual time.

Question 10

A patient from a different culture has passed away. According to tradition, the body is to be washed by members of the same sex as the patient; however, these individuals are not going to arrive at the hospital for several hours. Which of the following should the nurse do?

Accepted Answer

Desired care of the body immediately after death is an area that varies from one culture to the next. Some families desire to be involved in washing the body. Open communication with the family is of prime importance as the end of life approaches. There must be discussion of family desires as well as legal issues and institutional policies. The nurse should ensure that the deceased patient is not disturbed until the members arrive to conduct the ritualistic washing. Completing after-death care would not be appropriate since it does not take into consideration the patient's cultural needs. The nurse should not send the deceased patient to the morgue for the ritualistic washing to occur there.

Question 11

The nurse desires to learn more about a particular culture since more patients from that culture are being admitted to the hospital where she works. Which of the following can the nurse do to increase her knowledge?

Accepted Answer

Developing familiarity with a culture is an ongoing responsibility for nurses. Simple steps such as reading about the culture, attending festivals, and visiting with members of the population may prove invaluable in the nurse's practice. It would be unrealistic for the nurse to plan an extended vacation to the country of the culture's origin. Doing nothing would not be appropriate. Deciding to exercise no extra effort to learn about the culture is also inappropriate since a foundation of knowledge and understanding of the culture will provide a solid base for nursing care during difficult times.

Question 12

The family of a terminally ill patient tells the nurse that members of the patient's church are coming to the hospital to lay hands on him and invites the nurse to participate. The nurse does not believe in this intervention and does not want to participate. Which of the following should the nurse do?

Accepted Answer

Since the patient is a follower of a religion unfamiliar to the nurse, the nurse does not believe in the intervention and does not want to participate. She should decline to participate but offer to find another healthcare professional that is more comfortable. The nurse should not impose her own beliefs onto the patient or family by telling them that the intervention is inappropriate or that this type of intervention provides false hope and encourages denial. The nurse should not contact a member of the clergy without the patient's permission.

Question 13

A terminally ill patient tells the nurse that he is thankful for having a personal relationship with God and Jesus Christ since he realizes that death is a natural part of living and he is looking forward to meeting his maker. Which of the following does this information provide to the nurse?

Accepted Answer

A patient's own spirituality has proven to be the most powerful influence on coping ability and this patient's statement is evidence of that ability to cope. The patient's statement does not mean he is denying that he is going to die, that he will miss going to church, or that he thinks there is a heaven when there really is not.

Question 14

Which of the following can the nurse do to support a terminally ill patient's spiritual needs?

Accepted Answer

The nurse needs to differentiate spirituality from religiousness. To support the patient's spiritual needs, she should first assess the patient's spirituality. The nurse should not just assess the patient's religion and contact clergy to visit with him, or assume that the patient will want to follow religious rituals while in the hospital. Asking the patient if he believes in God and then expecting him to tell the nurse what can be done to support this beliefs is inappropriate.

Question 15

The newborn baby of a Roman Catholic patient has died. The mother is concerned that since the baby died before being baptized, he is doomed to live in purgatory. Which of the following can the nurse do to support this patient?

Accepted Answer

Often death will be approaching before there is time for the clergy to arrive. Christian baptism may be performed by any Christian in this situation, and it is often the nurse who will be asked by the family to perform the baptism. It is recommended that an outline of a baptism ceremony, along with a baptismal bowl, be kept available in areas such as neonatal intensive care units. Since the patient is Roman Catholic, the nurse should find a healthcare provider of the same faith to conduct the baptism. She should not counsel the mother about purgatory being a myth or explain that all newborns that die go directly to heaven. Keeping the baby in the morgue until a priest arrives to conduct a formal baptism of the child may not fulfill the mother's spiritual needs for herself or her child.

Question 16

The nurse is assigned to care for a patient from a culture with which she has limited experience. Which of the following should be done to ensure that this patient receives culturally competent care?

Accepted Answer

Certain nurses may be familiar with particular cultures, while others have familiarity with others. These nurses could be assigned to care for patients from the cultures with which they are most familiar, or they may serve as resources for other providers. The nurse should not be reminded that "a patient is a patient" regardless of culture of origin. Giving the nurse a pamphlet to read would not be sufficient. Assigning an interpreter to the nurse might be helpful when conducting an assessment; however, the interpreter would need to be present at all times since it cannot be predicted when the nurse will need to interact with the patient.

Question 17

A terminally ill patient tells the nurse that he hates being in the hospital because he is separated from the things that provides him with strength and support during this difficult time. Which of the following can the nurse do to support this patient?

Accepted Answer

The patient is telling the nurse that hospitalization separates him from things that provide him with strength and support. The nurse needs to find out what these things are and offer to supply him with the same or similar items. These items help the patient cope and should not be ignored. Telling the patient that he will be going home in a few days and that he will have to wait is not appropriate to support the patient's spiritual needs. Offering to pray with the patient or calling for a clergy member to visit him may or may not be appropriate.

Question 18

A nurse with experience caring for patients from a particular culture is admitting a patient from that culture. Which of the following should the nurse do to ensure the patient receives culturally sensitive care? 1) Question the patient regarding variations in rituals to find out why he does not follow the usual cultural beliefs and patterns

Accepted Answer

Even though a nurse may be very familiar with the traditions of a culture, it is always important to avoid stereotypes and assumptions. A person may be enmeshed in another culture through marriage, may have chosen not to participate in traditional practices, or may have developed variations in rituals and traditions. Although familiarity with a culture will still be helpful, the nurse must always assess the cultural needs of the individual patient and his family. Asking about traditions and practices will provide a solid foundation on which to build a therapeutic plan of care. The nurse should not plan care based upon previous patients' needs or assume that the patient's desires can be accommodated according to those of the majority of patients from the culture. The nurse should also not question why the patient prefers variations in rituals that differ from the usual cultural beliefs and patterns.

Question 19

Because of religious beliefs, a terminally ill patient is not accepting medication that could prolong and improve his quality of life. This decision is in violation of the nurse's beliefs. Which of the following should be done?

Accepted Answer

If delivery of culturally competent care conflicts with the nurse's personal system of beliefs and values, it is reasonable to transfer the care of the patient to a provider who is more accepting of the belief system of the patient. The nurse should not be reminded that every patient has the right to make their own decisions regarding healthcare. The nurse should not be given a verbal warning or suspended.

Question 20

A terminally ill patient tells the nurse that he misses attending mass at his church. Which of the following can the nurse do to help this patient?

Accepted Answer

The nurse needs to support the patient's spiritual needs at the end of life. The patient tells the nurse that he misses attending mass at church. The best intervention is to offer to find a religious service on the in-room television for the patient to watch and participate in. Asking him what he misses most about going to church is inappropriate. Offering to phone members of the congregation to come and visit the patient in the hospital might not fill the patient's spiritual needs. Reminding the patient that he is too weak to attend mass is also inappropriate.

Quiz 10: Cultural and Spiritual Care at the End of Life