A nursing student is preparing a presentation on cultural competence for a group of fellow nursing students. Which of the following statements should the student include in their explanation to best describe cultural competence in nursing?

A. Avoid standing in front of the client while speaking. This is incorrect because standing in front of the client allows them to see the nurse’s facial expressions and lip movements, which can aid in understanding. Good lighting and face-to-face positioning improve communication.
B. Speak loudly and slowly to the client to ensure they can hear you clearly. Speaking loudly can distort sounds, making it harder for hearing-impaired clients to understand speech. Instead, the nurse should speak clearly at a moderate pace and use other communication aids, such as written instructions.
C. Use written communication to supplement verbal instructions and ensure the client understands the information. This is the best approach, as written instructions help reinforce spoken communication, ensuring the client fully understands important details. This is especially useful for clients with significant hearing loss.
D. Use gestures and non-verbal cues only, without speaking, as the client is able to read lips effectively. While gestures and facial expressions help, not all hearing-impaired clients read lips fluently. Relying solely on non-verbal cues may lead to miscommunication. A combination of verbal, written, and visual communication is more effective.

Weight: The client has continued to lose weight (a total of 20 lb now), which suggests that their appetite and nutritional intake have not improved. This is a concern rather than a sign of progress, as poor nutrition can further impact emotional and physical well-being.

Sleep: The client reports sleeping longer, which suggests some improvement compared to the severe insomnia reported in the initial visit. While they still wake up feeling exhausted and have bad dreams, the ability to sleep for a longer duration is a step toward better rest.

Future plans: The client has made a significant decision about their teaching position by resigning. Although this may seem like a setback, it indicates that they are actively making decisions about their future rather than feeling stuck. Additionally, they report that they are thinking about seeking grief counseling or joining a support group, which shows willingness to seek help and engage in the healing process.

Anger: There is no mention of a reduction in anger. In the initial visit, the client expressed strong emotions about the unfairness of the loss, and the second visit does not indicate that these feelings have lessened or been processed in a healthy way.

Guilt: The notes do not indicate that the client has resolved their guilt over their partner’s death. The initial report showed strong self-blame, and without a statement suggesting a shift in perspective, guilt remains a barrier to healing.

Isolation: The client continues to describe limited social support and feels disconnected from friends and family. Although their adult children check in, the client still expresses a sense of emotional distance rather than re-engaging with relationships. Without active efforts to reconnect, isolation remains a concern rather than a sign of progress.