Chapter 06: Cultural Considerations for Pediatric Primary Care

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE CHOICE

1. The primary care pediatric nurse practitioner cares for children from a Native American
family and learns that they used many herbs to treat and prevent illness. Which approach will
the pediatric nurse practitioner use to promote optimum health in the children?
a. Ask about the types of practices used and when they are applied.
b. Provide a list of harmful herbs and ask the family to avoid those.
c. Suggest that the family avoid using these remedies in their children.
d. Tell the parents to use the herbs in conjunction with modern medications.
ANS: A
The challenge, when working with families from different cultural backgrounds, who use
alternative or complementary medicines, is to find ways to achieve a mutual understanding of
the differences and to negotiate an acceptable plan of care. The first step is to begin a
discussion about these practices. Providing a list of harmful herbs, suggesting that the family
avoid certain herbs, and suggesting that the herbs are only an adjunct to “modern medicine”
will sound disparaging and will convey a sense of mistrust.

2. The primary care pediatric nurse practitioner works with families from a variety of cultures
and socioeconomic classes. Which is an example of cultural humility in practice?
a. Giving health care advice that takes cultural differences into account
b. Identification of other cultures that may be superior to one’s own culture
c. Receptivity to learning about the perspectives of other cultures
d. Respecting other cultures while maintaining the views of one’s own
ANS: C
Cultural humility is defined as the lifelong commitment to developing mutually beneficial,
nonpaternalistic partnerships and is based on a model of passive volition, receptivity, and
being open to learning from others. Practitioners who have cultural humility are always
seeking to learn about other cultures. Cultural humility involves asking questions, rather than
giving answers. Cultural humility does not mean identifying one’s own culture as inferior.
Practitioners who are culturally competent are open to the influence of other cultures.

3. The primary care pediatric nurse practitioner in a community health center meets a family
who has recently immigrated to the United States who speak only Karon. They arrive in the
clinic with a church sponsor, who translates for them. The pediatric nurse practitioner notices
that the sponsor answers for the family without giving them time to speak. The pediatric nurse
practitioner will implement what intervention to help with communication?
a. Ask the sponsor to allow the family to respond.
b. Develop the plan of care and ask the sponsor to make sure it is followed.
c. Request that the sponsor translate written instructions for the family.
d. Use the telephone interpreter service to communicate with the family.
ANS: D
 Federally funded managed care networks and community health centers are required to have
interpreters accessible for clients with limited English proficiency. A commercial telephone
interpreter service has been shown to be as effective as an “in-person” interpreter. Relying on
family members or community members may not be reliable and may jeopardize patient
confidentiality. This interpreter is answering for the clients without hearing what they have to
say, which can compromise care.

4. The primary care pediatric nurse practitioner (PNP) prescribes a twice daily inhaled
corticosteroid for a 12-year-old child. At a well child visit, the child reports not using the
medication on a regular basis. Which response by the pediatric nurse practitioner
demonstrates an understanding of client-centered care?
a. Asking the child to describe usual daily routines and schedules
b. Referring the family to a social worker to help with medication compliance
c. Reviewing the asthma action plan with the parent and the child
d. Teaching the child how the medication will help to control asthma symptoms
ANS: A
In a client-centered relationship, there is reciprocal communication and understanding. The
PNP should be able to understand the client’s perspective and unique situation. The first step
is to evaluate possible reasons for nonadherence and not to make referrals or re-educate until
potential barriers have been identified and negotiation with the client has occurred.

5. A primary care pediatric nurse practitioner working in a community health center wishes to
develop a program to assist impoverished children and families to have access to healthy
foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of
such a program?
a. Asking community members to assist in researching and implementing a program
b. Designing a community garden approach that involves children and their parents
c. Gaining support from the corporate community to provide needed resources
d. Providing evidence-based information about the importance of a healthy diet
ANS: A
Community collaboration can be fostered through community-based participatory research
(CBPR), which is transformative research that bridges the gap between science and practice
by actively engaging communities with formally trained researchers. In this type of research,
community members formally participate in all aspects of the process, making the findings
more relevant to the community it affects the most. Designing a community garden approach
without first knowing whether the community needs or wants it does not ensure success.
Gaining support from the corporate community without input from the affected community
does not guarantee success. Giving evidence-based information does not involve the
community members in research and does not increase success.

6. The primary care pediatric nurse practitioner is examining a child whose parents recently
emigrated from a war-torn country in the Middle East. Which is a priority assessment when
performing the patient history?
a. Asking about physical, psychological, and emotional trauma
b. Determining the parents’ English language competency and literacy level
c. Learning about cultural preferences and complementary medicine practices
d. Reviewing the child’s previous health and illness records
ANS: A
Recent history that includes trauma, loss, and refugee camp experience may exacerbate
difficulties adjusting to life in the U.S. and can lead to acute and chronic physical and mental
health concerns. All of the other parts of the history will be necessary, but this should be a
priority, since the family has escaped a war-torn country.