Cultural Safety Issues (20 Questions)

1. You are working in a community health clinic in Northern Quebec. A mother of Inuit descent brings her 4-year-old daughter to the clinic. The child is in significant respiratory distress, with audible wheezing and a high fever. During the assessment, you note that the symptoms have been present for at least five days and have worsened significantly over the last 24 hours. The mother appears calm but tired.

Question:
To build a therapeutic alliance and understand the clinical context without imposing judgment, what is the most appropriate question to ask the mother regarding the delay in seeking medical help? *
2. You are caring for Mr. Singh, a 70-year-old Sikh patient admitted for surgery. He wears a turban and a steel bracelet (Kara). As you prepare him for the operating room, the surgical protocol states that all jewelry and head coverings must be removed. Mr. Singh becomes visibly distressed and refuses to remove the bracelet or his turban.

Question:
How should you navigate this conflict between hospital policy and the patient’s religious rights? *
3. Mrs. Chen, a recent immigrant from China, is hospitalized for heart failure. She speaks limited French. When you serve her the hospital lunch (a cold sandwich and iced water), she refuses to eat or drink it, looking concerned. Her daughter explains, "She cannot put cold things in her body right now; it is bad for her energy."

Question:
Based on the concept of cultural competence and the "Hot/Cold" theory of health common in many Asian cultures, what is your best response? *
4. You are working in a palliative care unit. An Indigenous Elder is admitted for end-of-life care. He tells you that he needs to perform a "Smudging" ceremony (burning sage/sweetgrass) to cleanse the space and prepare his spirit. The hospital has a strict "No Open Flame" policy due to oxygen sensors.

Question:
What is the culturally safe leadership action to take? *
5. A 25-year-old Muslim woman is admitted to the labor and delivery unit. She is in active labor. Her husband pulls you aside and requests, "Please, only female staff should be in the room. My wife is not comfortable with men seeing her uncovered." The on-call anesthesiologist and the resident physician tonight are both male.

Question:
How do you respond to this request? *
6. You are working in an outpatient clinic. You are providing discharge teaching to Mrs. Nguyen, an elderly Vietnamese patient who speaks limited French. Throughout your explanation of her new medication regimen, Mrs. Nguyen smiles constantly and nods her head every time you speak. However, when you ask if she has questions, she says nothing.

Question:
Based on cultural communication patterns common in some Asian cultures (high-context cultures), how should you interpret her non-verbal behavior? *
7. You are caring for Mr. Cohen, an Orthodox Jewish patient who has just passed away on your unit on a Friday afternoon (the beginning of Shabbat). You prepare to perform standard post-mortem care, which involves washing the body and changing the gown. The family intervenes and asks you not to touch or wash the deceased.

Question:
What is the appropriate nursing response to this request? *
8. You are admitting a 30-year-old female patient from a Middle Eastern background who is accompanied by her husband. As you begin the admission interview, asking the patient about her symptoms, her husband answers every question on her behalf. The patient sits quietly and looks at her husband while he speaks.

Question:
How should you navigate this dynamic to ensure accurate assessment while respecting cultural norms? *
9. You are caring for a First Nations patient who is scheduled for a below-the-knee amputation due to diabetic complications. He tells you that after the surgery, he wants the amputated limb returned to him rather than having it incinerated by the hospital as biohazard waste.

Question:
What is your response based on the understanding of Indigenous views on bodily integrity? *
10. You are working in the Emergency Department. A Muslim patient with Type 1 Diabetes comes in with hyperglycemia. It is the month of Ramadan, and he reveals that he has been fasting (no food or water) from sunrise to sunset. You are concerned about his unstable blood sugar.

Question:
What is the most effective approach to discuss his health management? *
11. You are assessing a patient from a Mediterranean culture who recently underwent abdominal surgery. His vital signs show a heart rate of 110 and BP 150/90. However, when you ask him to rate his pain, he smiles stoically and says, "It is okay, I am fine. I don't want to be a bother."

Question:
How does cultural awareness influence your pain management assessment in this case? *
12. A 55-year-old Indigenous man is admitted with pneumonia. He seems guarded and defensive. When you enter to take his vitals, he asks, "Are you going to experiment on me?" You notice in his chart that he is a survivor of the Residential School system.

Question:
What concept best explains his reaction, and how should you respond? *
13. You are working in a clinic. A young woman needs a gynecological exam. Her mother acts as her interpreter. The patient speaks some English but seems hesitant. You need to ask questions about sexual history and potential intimate partner violence.

Question:
What is the ethical and safe standard regarding the use of the mother as an interpreter in this scenario? *
14. A Jehovah’s Witness patient is admitted with a severe gastrointestinal bleed and a hemoglobin of 60 g/L. The physician orders a blood transfusion. The patient is alert, oriented, and refuses the blood, citing religious beliefs. You feel a strong moral distress because the patient might die without it.

Question:
According to the OIIQ Code of Ethics regarding patient autonomy, what is your duty? *
15. You are caring for Mrs. Garcia, a 75-year-old patient from a collectivist Latin American culture. She has just been diagnosed with Stage 4 pancreatic cancer. The physician is preparing to tell her the news. Her eldest son pulls you aside and says, "Please, do not tell my mother she is dying. It will destroy her hope. Tell me, and I will handle it."

Question:
How do you balance the Western legal requirement for truth-telling with the family's cultural protective values? *
16. You are the intake nurse in a mental health crisis center. You are assessing Mr. Simon, a 19-year-old First Nations man who presents with anxiety and depression. Throughout the interview, you notice that Mr. Simon keeps his head down, stares at the floor, and avoids making direct eye contact with you. He answers your questions in a soft, low voice.

Question:
How should you interpret this non-verbal behavior to avoid misdiagnosis or labeling? *
17. You are working in the pediatric emergency department. A mother from a Latin American background brings in her 6-month-old infant for dehydration. As you prepare to insert an IV cannula into the infant’s hand, you notice a red string with a small amulet (Azabache) tied around the baby’s wrist. You reach for your scissors to cut it off to clear the site. The mother grabs your hand and looks terrified, saying, "No! You cannot take that off, it protects him from the Evil Eye (Mal de Ojo)!"

Question:
What is the culturally safe nursing action? *
18. You are a community health nurse running a diabetes clinic on a reserve. You have a scheduled appointment with Mrs. Bear at 10:00 AM. She arrives at 11:15 AM, smiling, and explains, "I ran into my auntie at the store and she needed to talk, so I stayed with her." You are frustrated because this puts you behind schedule.

Question:
Understanding the difference between "Clock Time" (linear) and "Relational Time" (polychronic/cyclic), what is the appropriate response? *
19. You are working on a shared room unit. Mr. Tran, a Buddhist patient, is actively dying. His family has gathered at the bedside and they are chanting prayers in a rhythmic, monotone voice. The patient in the next bed rings the call bell and complains, "That noise is driving me crazy! Tell them to shut up."

Question:
How do you balance the spiritual needs of the dying patient with the comfort of the roommate? *
20. You are a public health nurse visiting the home of an Inuit family with a newborn baby. During the visit, you see that the baby is sleeping in the bed between the mother and father, tucked under a heavy duvet. You are concerned about SIDS (Sudden Infant Death Syndrome).

Question:
How do you approach this topic using a harm reduction and culturally safe framework? *