Question

Mr. Wong is a 78-year-old male from mainland China, who has been admitted for rehabilitation following total hip replacement surgery. He has a poor appetite, has experienced weight loss, and has been unable to participate in physical therapy. Thus, he is not meeting his goals for rehabilitation. No evidence exists to suggest an underlying disease process.

Ms. Faye, the nurse assigned to care for Mr. Wong is interested in learning what might be going on with Mr. Wong to better meet his treatment outcomes. Mrs. Faye considers the possibility that that he does not have adequate pain relief, which could affect his appetite and poor participation in physical therapy. She reviews his history to learn more about him. According the health history, Mr. Wong is a widower of 3 years; he has a son and daughter that live in distant cities. Mr. Wong emigrated from China at the age of 38 and only speaks Cantonese. He has lived in an ethic neighborhood with other Chinese American’s and has worked as a short-order cook in a Chinese restaurant since arriving in the United States 40 years ago.

Ms. Faye arranges for Mr. Lee, a Cantonese translator who is also Chinese, to help her ask Mr. Wong a few questions. She first asks Mr. Wong if he is in pain. When he responds no she follows with another question, asking him if he is depressed or anxious. Again, Mr. Wong responds no, that he is fine. During the interaction, Ms. Faye observes that Mr. Wong does not look at her or Mr. Lee, the translator.

After leaving the room, Ms. Faye expresses her frustration to Mr. Lee, mentioning how hard it will be to help him when he won’t communicate. Mr. Lee responds, “Older Chinese people believe that they must be stoic about pain, and there is a stigma about talking about any mental health problems.” This explanation had not occurred to Ms. Faye, who then recognizes her approach was may have been offensive and that she had failed to consider the underlying cultural differences beyond language.

Ms. Faye asks Mr. Lee to share more about traditional Chinese beliefs. She then asks Mr. Lee to help her ask additional questions using a cultural assessment form as a guide. After gathering additional information from Mr. Wong and gaining additional insight from Ms. Lee, Ms. Faye incorporates strategies that include changes to how his food is prepared and served, changes in approaches to pain management, and involving Mr. Wong’s son and daughter in his care.

Case Analysis

This case exemplifies culture in the context of health care delivery in many ways. First, it illustrates how some cultural information in a medical record may provide initial clues but does not substitute for conducting a through cultural assessment. Second, language can be a barrier to understanding even if a translator is available. Third, the nurse exhibited cultural bias and an initial lack of self-awareness of personal biases.

Question 1:

The pivotal construct of cultural competency is cultural desire, that is, the desire to understand people who differ from oneself. What actions on the part of a nurse would be indicative of cultural desire?

Question 2:

What examples can you identify from the case study that demonstrate that Ms. Faye respects and acknowledges Mr. Wong’s values, needs, and preferences?

Answer 1

1.The following actions on the part of the nurse would be indicative of cultural desire

• MS. Faye asking Ms. Lee and patient to share about the traditional Chinese beliefs
• Gathering additional information from the patient through Ms. Lee

2.The following things expose that Ms. Faye respects and acknowledges Mr. Wong 's values, needs and preferences by

• The changes made in the food preparation and serving (This is the most important part of all Chinese where they consider specific way of food preparation and serving ,it is a sort of respect given to them through the food)
• The changes mage in the approach to pain management(They believe the pain can be reduced by modifications in the diet ,lifestyle management ,complimentary services, etc.,)
• Involvement of family members in the care as Chinese tends to be with their family members and vice versa when they are ill .