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Culture

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Hmong Culture

Considerations

In beginning the interview, a consideration to remember is that eye contact is considered rude to Hmong People and that tone of voice and body language are very important; taking too loudly, placing too much emphasis on words, or talking excessively with hands and arm movements can result in noncompliance (Carteret, 2012). As this patient is young and assumed to be mainstream with Western culture, she will likely be understanding and forgiving of eye contact, tone, and body language but interactions with older family members will require care.

Gender of the nurse might play a role in some assessments, it is important to ask if a male nurse has permission to touch the abdomen or auscultate the lungs, heart, or abdomen. Questions pertaining to sex should be private and held with a nurse who is the same gender as the patient, it is of note that questions or examinations regarding sexual health can be misinterpreted as judgment of promiscuity, resulting in refusal, so sex must be addressed with much explanation and rationale without judgment (Carteret, 2012). As infection can be related to sex or sexual contact, this should be addressed with this patient.

The patient’s language preference for the interview is also important. The patient is a young adult and in college, however, her preference might be Hmong, or the language typically spoken at home. Another consideration is, does the patient want anyone else present for her interview/assessment? Hmong People have a family structure that is patriarchal, meaning, the father generally very involved in decision making and can, ultimately have the final say on a topic or treatment; the mother is caregiver and may wish to be present to help take care of the patient. Hmong Elders also play a large role in decision making, with a Grandfather that might want to talk directly with the doctor and make decisions over the wishes of the patient or patient’s father (Carteret, 2012).

Hmong Culture has roots in animism, which is the belief that objects, places, animals, people, etc. all have spirits and bodies that maintain a natural balance (Duffy, J., Harmon, R., Ranard, D.A., Thao, B., & Yang, K. (2004). The fever in this patient could be related to an imbalance in her spirit, an inhabitation by another sprit that is making her ill, disapproval of recent behavior by dead ancestors, or a curse (Carteret, 2012). The family might elect to have a religious healer, or Shaman visit to perform holistic medicine on the patient, some of this medicine might cause burns or pinch marks with coining or skin pinching being common practices for illness (Khuu, Yee, & Zhou, 2017). An understanding of Western medicine might not be present, the patient or family may ask for dosages of antibiotics for infection or acetaminophen of fever to be increase or decrease based on how they feel; it is important to explain that medications are dosed on scientific basis: height/weight, metabolism, excretion, and half-life. In fact, fever should be explained as the elevation in body temperature, generally related to an infection, as the word “fever” can poorly translate into “feeling unwell” or malaise in Hmong (Agency for Healthcare Research and Quality, 2007).

Resources

The hospital system that I work for has language related resources for Hmong patients. During normal business hours, Hmong interpreters can be scheduled or called-in for interviews, assessments, education, etc. so that the patient can have information delivered in their language of preference; these services are for the hospital, clinics, labs, and pharmacies. During off hours, we utilize Stratus Interpreter Services, which is an iPod that allows for audio and/or video interpretation that is considered more personal than the Language Line, or two phone system in which the nurse holds one phone and the patient holds the other with the interpreter interpreting between the two phones.

The Refugee Health Program through the Wisconsin Department of Health Services is another resource for healthcare (Wisconsin Department of Health Services, 2019). Hmong People were instrumental in the Vietnam War, as they were recruited by and fought for the US, becoming refugees and relocating here following the US pulling out of the war effort. This program helps address disparities in healthcare, insurance, etc. that refugees experience to help improve healthcare outcomes.

References

Agency for Healthcare Research and Quality (2007). Communicating with your Vietnamese patient. Cultural Clues. Retrieved from http://depts.washington.edu/pfes/PDFs/VietnameseCultureClue.pdf

Carteret, M., (2012). Providing healthcare to Hmong patients and families. Dimensions of Healthcare. Retrieved from https://www.dimensionsofculture.com/2012/01/providing-healthcare-to-hmong-patients-and-families/

Duffy, J., Harmon, R., Ranard, D.A., Thao, B., & Yang, K. (2004). The Hmong: an introduction to their history and culture. Culture Profile, (18).

Khuu, B.P., Lee, H.Y., & Zhou, A.Q. (2018). Health literacy and associated factors among Hmong American Immigrants: addressing the health disparities. Journal of Community Health, (43), 11-18.

Wisconsin Department of Health Services (2019). Refugee health program. Retrieved from https://www.dhs.wisconsin.gov/international/index.htm

 

(2) Reply 150 word reference and  citation 

Culture

Cultural practices and religious beliefs are the fabric of on which individuals determine the nature of their lives, shape their behavior, and take actions with respect to health and illness. These beliefs and practices are the foundation for accepting or rejecting various forms of nursing interventions, and formulating views on tenets of care, including uptake and use of self-care options. This sensitivity should not only focus on nursing care interventions but also in the manner which communication between the healthcare provider and the patent is carried out (Hordern, 2016) .The purpose of this paper therefore is to discuss the important issues to put into consideration when delivering care to a Hispanic 19-year old female college student who is to be admitted into a hospital for fever, and the necessary support structure for such a patient.

Considerations

The patient is from a traditional Hispanic home. She has been raised based on a value system that is shaped by both cultural and religious affiliations of this ethnic community. The implication of this is that the manner in which she will approach her illness, respond to it and be willing to open up will be governed by Hispanic cultural practices and religious beliefs (Sobel & Sawin, 2016). It is therefore important to be aware of a wide variety of issues when interviewing this patient. The first is the belief that loyalty to one’s extended family is more important than an individual’s needs and wellbeing as outlined in the practice of familismo. Owing to this practice, a Hispanic patient will rely on direction, advice, and encouragement from members of their family and are likely to directly involve them in any decision, including one involving their admission (Handtke, Schilgen, & Mösko, 2019). In considering familismo, I will consider the need for the patient to reach out to their parents or siblings for emotional support and their need to involve them in discussing admission, options of treatment, acceptance or rejection of various medications, among other treatment options. In addition to this, it is important to note that women, within Hispanic families, serve as the primary caretakers. They are highly knowledgeable on family health and are often able to provide information that may be useful in developing an accurate diagnosis (Handtke, Schilgen, & Mösko, 2019). Apart from the above, it will be important to consider the concept of personalismo. This is a concept in which Hispanic patients believe that care delivery can only be successful if they develop a relationship that is personal with their caregiver. As such, I will show genuine interest in this patient in order to open up about their condition. Should the patient fail to develop such a relationship, they will tend to hold back with the consequence being poor nursing care (Schmidt, 2019).

Resources

The biggest challenge with the delivery of healthcare services to Hispanic populations within the United States has been limited access to care owing to language barrier and low economic status (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis, & Escamilla-Cejudo, 2016). The support system in my community has focused on increasing access to care by minimizing language barrier. Policies that ensure that nurses who are fluent in understanding and speaking Spanish and English are always present when care is being provided to Hispanic patients, have been developed. Additionally, health promotion and health education materials targeting this group have been designed in a language that they can understand. Serving a diverse community requires delivery of culturally sensitive care. Such care requires understanding of cultural concepts that affect the health behaviors of such communities such as familismo and personalismo within the Hispanic community. It also requires developing support systems within the community to increase access to quality nursing care.

References

Handtke, O., Schilgen, B., & Mösko, a. M. (2019). Culturally competent healthcare

– A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PLoS One, 14(7), e0219971. doi:https://doi.org/10.1371/journal.pone.0219971

Hordern, J. (2016). Religion and culture. Medicine (Abingdon), 44(10), 589-592. doi:10.1016/j.mpmed.2016.07.011

Schmidt, K. (2019). How Do I Best Provide Spiritual Care to Hispanic Patients? Journal of Christian Nursing, 36(2), 125. doi:10.1097/CNJ.0000000000000595

Sobel, L. L., & Sawin, a. E. (2016). Guiding the Process of Culturally Competent Care With Hispanic Patients: A Grounded Theory Study. Journal of Transcultural Nursing, 27(3), 226–232. doi:https://doi.org/10.1177/1043659614558452

Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, &. J. (2016). Hispanic health in the USA: a scoping review of the literature. Public Health Reviews volume, 37(31). doi:https://doi.org/10.1186/s40985-016-0043-2

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