Fluent Essays

3 FACULTY DEVELOPMENT Test Item Development, Expert Rating, and CVI Calculation The following document is an example of the process that you will need to take in order to develop your own test questions. Step 1: Construct Test Purpose The purpose of this education is to improve the medical-surgical nurses’ knowledge in early recognition of patients who develop sepsis. The course will also provide education on documentation responsibilities and notification responsibilities in the care of patients with sepsis. It will also evaluate if the learners’ knowledge led to changes in practice behaviors (documentation of EMR sepsis screening every shift and notification of primary physician within 1 hour) after course completion. The last part will be measured using retrospective chart audits. Learning Objectives Upon successful completion of this course, you will be able to: · Differentiate between SIRs, severe sepsis, and septic shock · Describe physiologic changes associated with aging and sepsis · Recognize assessment findings that may be consistent with sepsis · Define the hospital policy and roles and responsibilities related to care of patients with sepsis Population The population is a general group of medical surgical nurses. Length of the Test The optimum length of this test is 10 questions. Difficulty and Discrimination Levels of Test Items According to Oermann and Gaberson (2014), a criterion-referenced test is frequently used in clinical settings because it is used to measure set standards rather than on the actual score itself. Since this test will be used for continuing education, low level to moderate difficulty questions should be used. Scoring Procedures to be Used The goal is to use a separate answer sheet that will then be used to develop a computer-generated item analysis report. Item Format The test will be a selected response multiple choice format Test Blueprint (there were originally 10 questions. In this example, we have listed 1) Content Level of Cognitive Skill K C AP AN Total SIRS 1 Continuum of sepsis 1 1 S/S of sepsis and elderly 1 1 Signs and symptoms of early sepsis 1 Hospital policy and management of the sepsis patient 1 1 1 1 Total 2 2 2 4 10 Sepsis Critical Thinking Questions 1) A 74 year old patient in the medical-surgical setting admitted 2 days ago for a hip fracture is confused, and incontinent. Her vitals from 2 hours ago were: BP: 123/78, HR: 89, R: 18, Temp: 97.8, and O2 Sat 95% on room air. The nurse would interpret the following as signs and symptoms of possible sepsis in older adults (Select all that apply) a) The patient has osteoporosis b) The patient has a HR of 88 c) The patient is confused d) The patient has no history of incontinence Answer: C&D Comprehension-Elderly signs and symptoms Rationale: Having osteoporosis does not place a patient at risk of sepsis. A HR of 88 would not be indicative of potential sepsis. New onset confusion and incontinence are commonly seen as potential signs of sepsis or infection (Nasa, Juneja, & Singh, 2012). 2) The medical-surgical nurse is receiving change of shift report on a 67 year old patient admitted for cellulitis of the left arm. The CNA reports that the patient’s vital signs are: BP: 70/46 (MAP 55), HR: 150, R: 22, Temp: 102.4, and O2 sat: 96% on room air. The patient appears weak and confused. Which of the following actions would the nurse do first? a) Call a code sepsis b) Notify the physician c) Call a rapid response d) Infuse 1 liter bolus of normal saline Answer: A Comprehension-Hospital Policy Rationale : Per hospital policy, the patient meets criteria for a code sepsis. Calling a code sepsis will not only activate immediate attention from the physician, but will also allow rapid response by laboratory, the ICU team, the shift supervisor, and needed fluid resuscitation (Valley Hospital Medical Center Policy, 2015). 3) The bedside nurse caring for a sepsis patient with a lactate of 2.2 understands that she has achieved the 3 hour sepsis bundle when she has (Select all that apply) a) Drawn the lactate and blood cultures b) Infused broad spectrum antibiotics after blood cultures are drawn c) Infused 2,040 ml of normal saline d) Inserted a foley catheter Answer: A, B, C Application-Hospital policy and care of the sepsis patient Rationale: The Surviving Sepsis Campaign Bundles 3 hour recommendations include: measuring lactate level, obtaining blood cultures prior to administration of antibiotics, administration of broad spectrum antibiotics, and administration of 30 ml/kg crystalloid for hypotension or lactate ≥ 4 mmol/L (Dellinger, et. al., 2012, p. 591). Inserting a foley catheter is not part of the SSC Bundle and invasive procedures should only be performed when absolutely necessary (NC Concept-Based Learning, 2011, pg. 788). 4) The nurse is caring for a patient diagnosed with sepsis who is on a sepsis protocol. A priority for this client is to maintain adequate tissue perfusion. Which of the following findings would indicate to the nurse that the patient’s condition is deteriorating? (Select all that apply) a) The lactate level changed from 1.7 to 3.1 b) The white blood count is 20,000 c) The patient’s urinary output has changed from 120 ml/hr to 25 ml/hr d) The patient’s blood pressure is 102/76 Answer: A Analysis-Continuum of sepsis Rationale: The SSC indicates that sepsis induced tissue hypo perfusion is indicated by a lactate level of ≥ 4mmol/L. An increased lactate level indicates that the patient’s perfusion is deteriorating (Dellinger, 2012, p. 587). The white blood count indicates infection, and urine output decrease indicate hypoperfusion. 5) Which of these patients is at highest risk of developing sepsis? a) A 35-year-old who has a closed ankle fracture b) A 10-year-old who has strep throat c) A 68-year-old with gallstones d) A 43-year-old who had chemotherapy yesterday Answer: D Knowledge-Signs and symptoms of sepsis Rationale: The patient who has undergone recent chemotherapy is immunocompromised and highly susceptible to infection (NC Concept-Based Learning, 2011, p. 90). 6) A 25 year old patient weighing 59 kg who is a direct admit with a diagnosis of pyelonephritis arrives to the medical-surgical unit. The patient’s vital signs are BP: 110/67 (MAP 87), HR: 114, R: 14, Temp: 100.7, and O2 sat 100% room air. Which of the following would indicate to the nurse that the patient’s condition has progressed to severe sepsis? a) The patient urinated 60 ccs of cloudy urine b) The patient has a WBC of 12,000 c) The patient has a lactate level of 2.9 d) The BP of 110/67 with a MAP of 87 and a HR of 114 Answer: C Analysis-Continuum of sepsis Rationale: The patient is urinating > 0.5 mL/kg/hr and therefore not indicative of kidney organ damage. A WBC of 12,000 is indicative of sepsis but does not confirm severe sepsis. A lactate level >2.0 is indicative of anaerobic metabolism and is indicative of hypoperfusion and severe sepsis. The BP of 110/67 is not abnormal and a HR of 114 and these two values alone do not indicate signs of severe sepsis (Kaplan, 2015). 7) The nurse is caring for a 67 year old patient admitted with pancreatitis with complaints of pain, nausea, and vomiting. He has a history of pancreatitis, and depression. The patient’s vital signs are BP: 140/65, HR: 125, R: 18, Temp: 98.4, O2 Sat 98% on RA. Which of the following findings may indicate to the nurse that the patient meet SIRS but does not sepsis criteria? a) The patient has a HR of 125 b) The patient has a WBC of 15,000 c) The patient has a history of depression d) The patient has a lactic acid level of 1.7 Answer: A Analysis-SIRS Rationale: The patient’s lactic acid level indicates that he is not experiencing anaerobic metabolism. A WBC of 15,000 and a HR of 125 could be related to infection, but dehydration could also cause these values. A history of depression has nothing to do with the analysis of SIRS/Sepsis. 8) A nurse is preceptoring a new graduate nurse caring for a patient diagnosed with suspected sepsis. The doctor ordered a sepsis protocol for this patient. What statement would indicate that the new graduate needs clarification on the 3 hour sepsis protocol bundle? a) “I will monitor the patient’s urine output to make sure she is urinating >30 ml/hr” b) “The lactate was drawn 1 hour ago. I will redraw a lactate level in an hour” c) “As soon as I am done infusing this antibiotic, I will draw the blood cultures” d) “If the patient’s MAP is <65, we will hang a 30 ml/kg normal saline bolus” Answer: C Analysis-Hospital Policy & Management of Sepsis Patient Rationale: Blood cultures should be drawn before administration of antibiotics. The other 3 statements meet the goals of the 3 hour bundle. 9) During documentation, a nurse reviewing her orders notices that a patient she is caring for has triggered a sepsis alert on her EMR for a HR: 120, Temp: 101, and Lactate of 3.1. The nurse demonstrates understanding of the sepsis notification when a) The nurse contacts the patient’s primary care physician within an hour b) The nurse initiates the sepsis protocol c) The nurse prepares to transfer the patient to the ICU d) The nurse completes a sepsis screening Answer: A Knowledge-Hospital Policy Rationale: The goal of EGDT is to improve patient outcomes by implementing therapy as soon as sepsis is recognized. (Dellinger, et. al, 2013). The hospital policy states that the nurse needs to notify the physician within 1 hour of sepsis alert. 10. The nurse demonstrates understanding of the sepsis screening tool use when a) It is documented only on patients who are suspected of sepsis b) It is documented on all patients at the time of admission c) It is documented on all patients every 24 hours d) It is documented on all patients every shift Answer: D Knowledge-Hospital Policy Rationale: Per policy, every patient must have a sepsis screening completed every shift. Although the majority of patients who meet sepsis criteria are identified in the ED, approximately 24% of patients develop sepsis during their admission. Step 2: Submit your test questions to your course instructor for review Step 3: Develop your Expert Rating Form and Distribute to Each Expert Experts Rating Form Instructions Rating instructions: For each item, please indicate the following: Please rate how relevant each item is to the overall construct of early sepsis identification and care by placing a number in the first box to the right of each item. 1 = Not relevant at all 2 = Slightly relevant 3 = Moderately relevant 4= Highly relevant Your honest feedback is appreciated and will be used to enhance the quality of this questionnaire. Expert Rating Form Item Relevance Rating A 74 year old patient in the medical-surgical setting admitted 2 days ago for a hip fracture is confused, and incontinent. Her vitals from 2 hours ago were: BP: 123/78, HR: 89, R: 18, Temp: 97.8, and O2 Sat 95% on room air. The nurse would interpret the following as signs and symptoms of possible sepsis in older adults (Select all that apply) a) The patient has osteoporosis b) The patient has a HR of 88 c) The patient is confused d) The patient has no history of incontinence The medical-surgical nurse is receiving change of shift report on a 67 year old patient admitted for cellulitis of the left arm. The CNA reports that the patient’s vital signs are: BP: 70/46 (MAP 55), HR: 150, R: 22, Temp: 102.4, and O2 sat: 96% on room air. The patient appears weak and confused. Which of the following actions would the nurse do first? a) Call a code sepsis b) Notify the physician c) Call a rapid response d) Infuse 1 liter bolus of normal saline The bedside nurse caring for a sepsis patient with a lactate of 2.2 understands that she has achieved the 3 hour sepsis bundle when she has (Select all that apply) a) Drawn the lactate and blood cultures b) Infused broad spectrum antibiotics after blood cultures are drawn c) Infused 2,040 ml of normal saline d) Inserted a foley catheter The nurse is caring for a patient diagnosed with sepsis who is on a sepsis protocol. A priority for this client is to maintain adequate tissue perfusion. Which of the following findings would indicate to the nurse that the patient’s condition is deteriorating? (Select all that apply) a) The lactate level changed from 1.7 to 3.1 b) The white blood count is 20,000 c) The patient’s urinary output has changed from 120 ml/hr to 25 ml/hr d) The patient’s blood pressure is 102 Which of these patients is at highest risk of developing sepsis? a) A 35-year-old who has a closed ankle fracture b) A 10-year-old who has strep throat c) A 68-year-old with gallstones d) A 43-year-old who had chemotherapy yesterday A 25 year old patient weighing 59 kg who is a direct admit with a diagnosis of pyelonephritis arrives to the medical-surgical unit. The patient’s vital signs are BP: 110/67 (MAP 87), HR: 114, R: 14, Temp: 100.7, and O2 sat 100% room air. Which of the following would indicate to the nurse that the patient’s condition has progressed to severe sepsis? a) The patient urinated 60 ccs of cloudy urine b) The patient has a WBC of 12,000 c) The patient has a lactate level of 2.9 d) The BP of 110/67 with a MAP of 87 and a HR of 114 The nurse is caring for a 67 year old patient admitted with pancreatitis with complaints of pain, nausea, and vomiting. He has a history of pancreatitis, and depression. The patient’s vital signs are BP: 140/65, HR: 125, R: 18, Temp: 98.4, O2 Sat 98% on RA. Which of the following findings may indicate to the nurse that the patient meet SIRS but does not sepsis criteria? a) The patient has a HR of 125 b) The patient has a WBC of 15,000 c) The patient has a history of depression d) The patient has a lactic acid level of 1.7 A nurse is precepting a new graduate nurse caring for a patient diagnosed with suspected sepsis. The doctor ordered a sepsis protocol for this patient. What statement would indicate that the new graduate needs clarification on the 3 hour sepsis protocol bundle? a) “I will monitor the patient’s urine output to make sure she is urinating >30 ml/hr” b) “The lactate was drawn 1 hour ago. I will redraw a lactate level in an hour” c) “As soon as I am done infusing this antibiotic, I will draw the blood cultures” d) “If the patient’s MAP is <65, we will hang a 30 ml/kg normal saline bolus” During documentation, a nurse reviewing her orders notices that a patient she is caring for has triggered a sepsis alert on her EMR for a HR: 120, Temp: 101, and Lactate of 3.1. The nurse demonstrates understanding of the sepsis notification when a) The nurse contacts the patient’s primary care physician within an hour b) The nurse initiates the sepsis protocol c) The nurse prepares to transfer the patient to the ICU d) The nurse completes a sepsis screening The nurse demonstrates understanding of the sepsis screening tool use when a) It is documented only on patients who are suspected of sepsis b) It is documented on all patients at the time of admission c) It is documented on all patients every 24 hours d) It is documented on all patients every shift Step 3: Calculate your Content Validity Index Content Validity Index Table Item Expert 1 Expert 2 Expert 3 Mean 1 3 4 4 3.67 2 2 1 3 1.8 3 4 4 4 4.0 4 4 3 3 3.67 5 4 4 4 4.0 6 3 3 4 3.33 7 4 3 4 3.67 8 4 4 4 4.0 9 4 3 4 3.67 10 4 4 4 4.0 The procedure consists of having experts rate items on a four-point scale of relevance. Then, for each item, the item (CVI) (I-CVI) is computed as the number of experts giving a rating of 3 or 4, divided by the number of experts-the proportion in agreement about relevance. The content validity index is calculated using the following formula: CVR = [(E-(N/2)) / (N/2)] with E representing the number of judges who rated the item as Moderately Relevant or Highly Relevant and N being the total number of judges. The mean total of all of the means was 3.09 indicating that all of the questions were moderately/highly relevant. The calculation is as follows: CVR = [(3-(3/2)) / (3/2)] CVR = [(3-1.5) /1.5] CVR = 1.5/1.5 2 Test Item Development, Expert Rating, and CVI Calculation Chidinma Ogundu Touro University Test Construction Purpose The purpose of this document is to assess the healthcare professionals’ level of cultural competence regarding the African immigrant group. The information in the document will be used as guidance in the implementation of the health care professionals’ cultural competence training program for African immigrants and when handing out a resources toolkit for African immigrant patients. Objectives To assess understating of the participants regarding the basics of cultural competence. To evaluate the participant’s knowledge on the effects of cultural incompetence when attending to African immigrants. To examine the participant’s understanding on the basic resources needed by African immigrants as related to health care. To evaluate the participant’s understanding regarding the challenges faced by African immigrants as they relate to health care. To determine the participant’s understanding of the solutions to these challenges faced by African immigrants. Population The population is made up of healthcare professionals attending to African immigrants who visit the clinic for primary care services. Length of the Test The test has a maximum of 10 questions. Difficulty and Discrimination Levels of Test Items The test contains questions ranging from low-level to moderate level of difficulty. Scoring Procedures to be Used The aim is to use a separate answer sheet which can then be used in developing a computer-generated item analysis report. Item Format The test is in the form of a selected response multiple choice format. Test Blueprint Content Level of Cognitive Skill K C AP AN Total Basics of cultural competence 1 1 1 Effects of Cultural Incompetence 1 1 Basic resources for African immigrants 1 Healthcare-related challenges faced by African immigrants 1 1 Solutions to the challenges 1 1 Total 1 2 2 5 10 General Directions for the Test (Please answer all the questions to the best of your ability. Please circle the most appropriate answer. Kindly note that your responses are strictly confidential and will only be seen by the appropriate leader(s) of the project. Your participation is highly valued. Thank you!) Questions 1. What is cultural competence in healthcare? A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage. B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact. C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients. Answer: C. Knowledge- Basics of Cultural Competence Rationale: All the definitions above are related to important terms in cultural issues of healthcare but the definition in option C is the meaning of cultural competence in healthcare (Allison et al., 2016). Option A defines Cultural sensitivity, Option B defines Cultural diversity, and Option D defines Cultural humility. Even though the terms are inter-related, understanding the correct definition of cultural competence is the first step to ensuring that all the other terms are understood appropriately (Allison et al., 2016). 2. A healthcare professional will know that he/she is culturally competent when A. He/ she has successfully completed a cultural competence program. B. He/she is able to obtain knowledge of a patient's individualized culturally-influenced worldview and how their culture affects their physical and mental health. C. He/she is able to answer key cultural competence questions regarding a particular cultural group. D. He/she is able to treat a patient belonging to a different culture. Answer: B Comprehension- Basics of Cultural Competence Rationale: The only way to measure the cultural competence of a healthcare professional is by assessing their ability to look at healthcare needs and experience from the view of the patient (Allison et al., 2016). Completing a cultural competence program and answering cultural questions are only the first way to sharpening one’s cultural competence skills. Treating a patient from a different culture does not indicate cultural competence because the quality of the care the patient’s healthcare experience have not been discussed (Allison et al., 2016). 3. Which of the following would not be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient? A. Difficulty understanding medical instructions. B. Problem with the reliability of information. C. Possible medical errors. D. Increased readmission for the patient. Answer: D Application-Effects of Cultural Incompetence Rationale: While increased readmissions of patient may be a possible effect of language barrier between a healthcare professional and a patient, it is not immediate. All the other three options are likely to emerge during the communication session. The readmission effect may be noticed after a period of time (about 30 days). Additionally, the immediate effects can be resolved through ways such as interpretation hence improving the healthcare outcome and preventing the readmission (Allison et al., 2016). 4. Which of the following is not a basic resource needed by African immigrants as they seek healthcare services? A. Legal Resources B. Housing Resources C. Food Assistance Resources D. Finance Aid Resources Answer: A Analysis- Basic resources for African immigrants Rationale: Apart from legal resources, all the other resources have a direct impact on an African immigrant seeking healthcare services (Chikanda & Morris, 2021). For example, poor housing may result in poor health through ways like increased allergens and risk for cardiovascular diseases. Lack of food and poor nutrition can cause certain diseases and negatively affect the mental health, energy levels, and general well-being. Lack of finance and poverty limit the resources that the African immigrants can use to avoid health risks and implement healthy behaviors (Chikanda & Morris, 2021. 5. The main reason for cultural competence in healthcare is A. Delivering quality care. B. Improving cultural awareness. C. Demographic change D. Changing policies. Answer: C Analysis- Basics of cultural competence Rationale: The main reason for cultural competence in healthcare is the demographic shifts which exert pressure on health systems and demand for new directions to be applied in the delivery of care (Chikanda & Morris, 2021). All the other listed options (A, B, D) are ways of adapting to the newer forms of delivering quality care for everyone (Chikanda & Morris, 2021). 6. What is the relationship between poverty and quality care among African immigrants? A. African immigrants are barred from accessing healthcare when needed. B. African immigrants are not able to purchase those things that are needed for good health. C. B only. D. A and B. Answer: D Analysis- Healthcare-related challenges faced by African immigrants Rationale: The relationship between poverty and quality care among African immigrants is financial (Omenka et al., 2020). They are not able to purchase those things that are needed for good health and this prevents them from accessing quality care when needed (Omenka et al., 2020). 7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ? A. Failing to understand the social determinants of the health of the patient. B. Failing to communicate in the patient’s language. C. Involving a third party (e.g. translator) to help in the communication process. D. All of the above. Answer: A Application- Effects of cultural incompetence Rationale: African immigrants have unfavorable social determinants of health which contribute to their lack of quality healthcare (Chikanda & Morris, 2021). A healthcare provider is culturally incompetent if he/she cannot understand these social determinants of health because the lack of understanding will lead to poor attendance to the patient and a subsequent poor health experience (Omenka et al., 2020). 8. African immigrants may fear seeking health care services due to the following reasons except : A. Fear of racial discrimination. B. Difference in culture and beliefs. C. Fear of new environments. D. Inability to pay for the services. Answer: C A pplication- Healthcare-related challenges faced by African immigrants Rationale: By agreeing to move into a newer country, the African immigrants show that they have made peace with the idea of newer environments and may be focused on how to adapt rather than the fear of the environments (Chikanda & Morris, 2021). However, all the other three are reported to be leading causes of African immigrants failing to seek healthcare services (Chikanda & Morris, 2021). 9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would not provide solutions to the communication barrier you are experiencing? A. Finding an effective translating software. B. Asking a (present) member of the family to provide interpretation in the communication process. C. Seeking the services of a professional interpreter. D. All of the above. Answer: B Analysis- Solutions to the challenges Rationale: Relatives have an emotional involvement, their language ability is untested, and they do not possess any skills regarding medical terminology (Allison et al., 2016). Additionally, using as interpreters is breaches confidentiality for the patient and there is lack of guarantee of impartiality or professional conduct (Allison et al., 2016). 10. Which of the following is an example of an immediate remedy for a cultural challenge when attending to African immigrants? A. Learning about different cultures. B. Employing diversity training. C. Ensuring effective communication. D. Working towards cultural humility. Answer: C Comprehension- Solutions to the challenges Rationale: An effective communication strategy can provide an immediate solution to language barrier which is a common challenge when attending to African immigrants(Chikanda & Morris, 2021). All the other strategies are long-term solutions and they also require long-term planning (Omenka et al., 2020). Experts Rating Form Instructions Rating instructions: For each item, please indicate the following: Please rate how relevant each item is to the assessment of the cultural competence of health care professionals regarding African immigrants by placing a number in the first box to the right of each item. 1 = Not relevant at all 2 = Slightly relevant 3 = Moderately relevant 4= Highly relevant Expert Rating Form Item Relevance Rating 1. What is cultural competence in healthcare? A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage. B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact. C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients. 2. A healthcare professional will know that he/she is culturally competent when A. He/ she has successfully completed a cultural competence program. B. He/she is able to obtain knowledge of a patient's individualized culturally-influenced worldview and how their culture affects their physical and mental health. C. He/she is able to answer key cultural competence questions regarding a particular cultural group. D. He/she is able to treat a patient belonging to a different culture. 3. Which of the following would not be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient? A. Difficulty understanding medical instructions. B. Problem with the reliability of information. C. Possible medical errors. D. Increased readmission for the patient. 4. Which of the following is not a basic resource needed by African immigrants as they seek healthcare services? A. Legal Resources B. Housing Resources C. Food Assistance Resources D. Finance Aid Resources 5. The main reason for cultural competence in healthcare is A. Delivering quality care. B. Improving cultural awareness. C. Demographic change D. Changing policies. 6. What is the relationship between poverty and quality care among African immigrants? A. African immigrants are barred from accessing healthcare when needed. B. African immigrants are not able to purchase those things that are needed for good health. C. B only. D. A and B. 7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ? A. Failing to understand the social determinants of the health of the patient. B. Failing to communicate in the patient’s language. C. Involving a third party (e.g. translator) to help in the communication process. D. All of the above. 8. African immigrants may fear seeking health care services due to the following reasons except : A. Fear of racial discrimination. B. Difference in culture and beliefs. C. Fear of new environments. D. Inability to pay for the services. 9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would not provide solutions to the communication barrier you are experiencing? A. Finding an effective translating software. B. Asking a (present) member of the family to provide interpretation in the communication process. C. Seeking the services of a professional interpreter. D. All of the above. 10. Which of the following is an example of an immediate remedy for a cultural challenge when attending to African immigrants? A. Learning about different cultures. B. Employing diversity training. C. Ensuring effective communication. D. Working towards cultural humility. Content Validity Index Table Item Expert 1 Expert 2 Expert 3 Mean 1 2 3 4 5 6 7 8 9 10 (The procedure consists of having experts rate items on a four-point scale of relevance. Then, for each item, the item (CVI) (I-CVI) is computed as the number of experts giving a rating of 3 or 4, divided by the number of experts-the proportion in agreement about relevance) References Allison, K. W., Echemendia, R. J., Crawford, I., & Robinson, W. L. (2016). Predicting cultural competence: Implications for practice and training. Professional Psychology: Research and Practice, 27(4), 386. Chikanda, A., & Morris, J. S. (2021). Assessing the integration outcomes of African immigrants in the United States. African Geographical Review, 40(1), 1-18. Omenka, O. I., Watson, D. P., &amp; Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC public health, 20(1), 1-13.