Need Advice on Proctored Question

NeoPediRN · Jun 14, 2009

That's kind of a loaded question to ask someone trying to get INTO a nursing program, as culturally competent care is something you learn throughout the program and it is ridiculous to expect the person applying even understands assessment. I would go with something along the lines of knowing the foundations of culture, knowing that in some cultures women do not make eye contact, that the husband speaks for the wife and makes decisions, that you make sure to brush up on their kardex before entering to know if there are any spiritual/cultural issues you will need to address...such as asking a patient if dietary has seen them to help choose a menu that suits their religious needs, etc...you should start your assessment by smiling and introducing yourself. Note their response. Do they say hi back, do they avert their eyes, do they speak English and understand what you're saying? Make sure that a language line or interpreter is accessible if you are caring for a non-English speaking patient. Also understand that you will have to reserve judgment. You will come across all kinds of lifestyles, from frequent flyer drug users to the 18-year-old single mom with five children and plans for more because the state pays her for it, to people who abuse to their bodies in every way possible. You will also find varying levels of education and socioeconomic status. Your jobs is to provide education and support, and to offer resources. Also, in having a conversation with your patient you may find important things that were not passed on, like a recent bankruptcy, foreclosure, thoughts/history of self harm, etc that may need further investigating by the team.

You will constantly use your assessment skills to meet your patients needs, and you will find yourself frustrated at times in caring for a patient of a certain background/ethnicity who is at such high risk for heart disease/stroke/blood clots/htn/diabetes and says she's managing it but when you ask her what her last meal was like she tells you it consisted of two big macs and a fried fish sandwich. You will evaluate your elderly patient and find his BP is 210/104 and he has a headache but tells you he already said he doesn't have a history of hypertension and yes he did take all of his medicine before he came to the ER. You inform him his blood pressure is high and he may need medicine to help it come down, then he turns to you and says "oh, you know, there is this one pill I used to take for my blood pressure, it's round and white, about this big 'o' but I haven't taken it in two weeks because my insurance changed and the copay is too high now." You wouldn't know about your first patient's dietary habits or that your second patient didn't know that hypertension meant high blood pressure until you dug a little deeper....you also just learned that you should put in a nutrition consult and add "altered nutritional status" in your patient's nursing interventions for the first patient, and you learned that your second patient needs a social services consult to figure out what to do about not being able to afford the medicine, and you need to inform the doctor that the medication reconciliation form is incomplete because his blood pressure medicine wasn't listed so that MD can call the pharmacy and go from there....all this from a two minute interaction where you understood the patients' backgrounds and risks so you asked focused questions. When it comes to evaluating outcomes, return demonstration is the best method. What did the patient do to show you they really do understand? Did you print off a med teaching sheet for that hypertensive patient? Can he tell you what the med is and how he should take it, and point out that medicine from his 10 other pills that look alike/sound alike? What does your multi risk factor patient tell you about her lifestyle? Does she know what kind of diet she should follow? Does she have plans to comply? Keep in mind nursing schools want to hear what you're going to do in the ideal world, you're not allowed to get jaded by the reality of nursing and the fact that you will have five other patients with equal needs and not enough time to do everything until after graduation.

Also, another important key in culturally competent care is to find out their feelings about their illness. Some cultures believe that illness is a punishment from their god(s), others believe illness is a fate and not viewed as a negative thing. Some cultures use remedies of a holistic nature and finding faith in western medicine is a struggle for them. Being a nurse isn't just about making sure medications are passed on time or bandages are changed, it is truly about nursing the patient as a whole, from head to toe, heart to soul.

Here are a few links to help you further, best of luck!

http://ccn.aacnjournals.org/cgi/reprint/24/4/48.pdf

http://www.culturediversity.org/cultcomp.htm

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume112006/No3Sept06/ArticlePreviousTopics/CulturallyCompetentNursingCare.aspx

http://www.articlesbase.com/careers-articles/american-nursing-today-culturally-competent-care-556887.html

CanbyCarol · Jun 14, 2009

Thank you soooo much. :thankya: You have helped me alot! I thought it was a pretty tough question for someone just applying to nursing school, glad it was not just my thought.

Do you think it would be a good idea to add in the reply to this question something along the lines of, "I look forward to learning more about this subject in the nursing program"?

Thanks, Carol

2BSure · Jun 14, 2009

I think this question is a bit much for someone who is applying for NS.

CanbyCarol · Jun 14, 2009

I wonder why they chose such a tough question? The school told me that they only have so many spots to fill and have a whole lot of applicants, which may be why. Besides this one proctored question there are 5 more essay questions that I have to do. I hope I get in!