A nurse caring for a 65-year-old Vietnamese-speaking patient newly admitted for heart failure recognizes that cultural and linguistic differences may affect care. Which actions reflect culturally competent nursing practice consistent with the National CLAS Standards? Select all that apply.

Correct: 1, 2, 4, 5, 6. The HHS Office of Minority Health National CLAS Standards (Culturally and Linguistically Appropriate Services) establish 15 standards for equitable care; key nursing applications include qualified interpreters, plain-language communication, cultural assessment, and reflective practice. (1) Family members — especially children — should NOT serve as medical interpreters because of accuracy errors, confidentiality breaches, role confusion, and emotional bias; certified medical interpreters (in-person, telephonic, or video) are required by Title VI of the Civil Rights Act for facilities receiving federal funding. (2) Speak in first person to the patient ("Mr. Nguyen, how is your breathing today?") and watch the patient, not the interpreter; pause every 1-3 sentences to maintain accuracy. (4) Cultural humility = lifelong reflective practice that recognizes the patient as the expert on their own culture; pairs with implicit bias awareness because all clinicians have unconscious associations that affect care. (5) The LEARN model — Listen, Explain, Acknowledge, Recommend, Negotiate — is a structured communication tool to bridge cultural differences and build shared treatment plans. (6) Health literacy plus language access requires written materials in the patient preferred language at appropriate reading level AND verification by teach-back rather than "Do you understand?" which often elicits social-desirability "yes" without true comprehension. Incorrect: (3) Asking about traditional health beliefs and herbal remedies is a CORE component of cultural assessment; it builds trust, avoids drug interactions (e.g., ginseng-warfarin, St. John wort-SSRI), and uncovers concurrent practices the patient may otherwise hide.