Which action indicates the nurse is meeting a primary goal of culturally competent care for marginalized patients?

Choice A reason: Depression is strongly linked to insomnia in older adults, causing difficulty falling asleep due to rumination, low mood, or altered sleep architecture. Assessing for depression is critical, as it may underlie the sleep disturbance, requiring targeted interventions like therapy or antidepressants to improve sleep and mental health.

Choice B reason: Muscle fatigue may cause physical discomfort but is not a primary cause of difficulty falling asleep. It is more likely to affect sleep quality than initiation. Depression is a more common and significant contributor to insomnia in older adults, making this an incorrect choice.

Choice C reason: Hypertension can be associated with sleep apnea but is not directly linked to difficulty falling asleep. It may result from poor sleep but is less likely the cause. Depression is a more prevalent cause of insomnia, making this a less relevant condition to assess.

Choice D reason: Hypothyroidism can cause fatigue and sleepiness, not difficulty falling asleep. It is less commonly associated with insomnia compared to depression, which significantly disrupts sleep onset in older adults. This condition is less relevant to the patient’s presentation, making it incorrect.

Choice A reason: Jumping in to provide patient comfort, while well-intentioned, implies reactive or task-oriented actions rather than the intentional, empathetic engagement of presence. Presence involves being emotionally available, fostering trust and connection, not just addressing immediate physical needs. This choice risks misrepresenting the holistic, relational aspect of presence critical for patient and family support.

Choice B reason: Being there without an identified goal does not fully capture presence, which is purposeful in fostering emotional and spiritual support. Presence involves intentional closeness and caring, not aimless attendance. This choice underestimates the nurse’s role in creating a therapeutic environment, potentially diminishing the impact of presence on patient and family well-being.

Choice C reason: Focusing on tasks prioritizes technical care over emotional connection, contrary to presence, which emphasizes being with the patient holistically. Task-oriented care may address physical needs but neglects the relational support central to presence. This choice misaligns with the concept, risking a purely functional approach that overlooks emotional and spiritual care needs.

Choice D reason: Providing closeness and a sense of caring defines presence, a nursing action rooted in Watson’s caring theory. It involves empathetic engagement, active listening, and emotional availability, fostering trust and comfort for patients and families. This intentional connection supports holistic care, enhancing psychological well-being and coping during challenging moments like illness or end-of-life care.