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Dealing with patients from a variety of cultures means to encounter diverse expectations and perceptions regarding healthcare system. In fact, it is common to meet patients who interpret health and illnesses in different ways, according to their cultural backgrounds. The practices that might be reasonable to some people might appear harmful to others. Therefore, it is imperative for healthcare providers to understand their patients and to deliver appropriate health services that accommodate their beliefs and values. Most importantly, nurses must take the cultural aspect of patients into serious consideration because they have closer contact with patients than any other healthcare providers. This paper explains a case scenario of an ethical dilemma of a couple from different cultural backgrounds, focuses on the reaction of the couple and the nurses, and, finally, defines culturally congruent care.

 

Ethical Dilemma

Ever since I started my nursing clinical placements, I have encountered many patients who perceive healthcare and illnesses differently. When taking the history from the patients, I noticed that not all of them are willing to provide comprehensive information about their illnesses. The same situation happened when a woman of Asian origin together with her Caucasian husband came to the hospital with their 6-year-old male child who presented with symptoms of fever and coughing.

The nurse in charge of the unit gave me the responsibility of taking the history of the child from the mother. During information gathering, the child was persistently coughing and shivering. When I asked the mother about the history of present illness, she said that the child had begun exhibiting the same symptoms three weeks before. However, she thought they were mild symptoms and tried to reduce them. I asked what she had used to treat the child, but she was reluctant to reveal. When I insisted, she said she had to do ‘cao gio’ because her parents taught her that it reduces the symptoms. I asked her if she had done it, and she exposed the torso of her son, which was severely bruised with some bleeding. I did not understand what ‘cao gio’ meant and asked the father to explain it to me. I noticed that the facial expression of the father changed. Instead of answering me, he started questioning the mother in a harsh tone why she had performed such an ‘evil’ act on the child.

I calmed the couple to prevent them from attracting the attention of people who were around. I then asked if they had agreed to perform ‘cao gio.’ The father said he lived far away from the family because of work but visited them twice a week. Besides, he was not aware of what ‘cao gio’ meant. The mother explained that ‘cao gio’ raises bad blood and helps people to heal quickly.

When I began collecting the family history and social data, I noticed that the couple had been married for two years. However, they did not spend much time together to understand the background of each other. I called the nurse in charge, and she noticed the bruises on the torso of the child. The nurse said it was a common practice among people of Asian origin. It should not be a warning sign since they were in the hospital and would receive appropriate medical and nursing care. Further diagnostic tests revealed that the child had acute bronchitis.

Before treatment began, the nurse in charge took the couple in a private room for counseling. The nurse invited me to the counseling procedure to help me handle such scenarios efficiently the next time. The nurse asked both the mother and the father about their backgrounds and noticed that the mother had been an immigrant for eight years. She began the relationship with the father immediately she arrived. They had a child together but decided to legalize their marriage six years later because the parents of the mother had condemned the union due to the differences in cultural values.

The nurse advised her that fever and cough in pediatric patients are serious symptoms and should be managed in hospital settings. Moreover, she helped the father to understand the ‘cao gio’ practice and told him that the child would feel better after treatment. However, she recommended the couple to negotiate before conducting any interventions in the child’s health. The couple looked satisfied and talked to each other well after the interview.

Perception of the Dilemma

The view of the Dilemma by All Involved Parties

The father, the mother, the nurse in charge, and I perceived the dilemma differently. The mother did not have an issue with the practice of ‘cao gio’ because she stated that her family had been practicing it without any problems. Therefore, she showed the willingness to continue with it. The father was furious because he did not understand what ‘cao gio’ meant. He seemed angry after noticing the bruises and termed it as an ‘evil’ act. Though, he was confused about how to tell his wife to abandon the practice, which she believed in so much. It was my first time when I encountered such a controversial scenario. I noticed that the bruises were developing an infection. After, I called the nurse in charge that had much experience in handling such patients. She counseled the parents, and both agreed to seek medical care in case of any abnormality with the physiological functions of the child. Indeed, Andrews and Boyle ascertain that the critical analysis of patients’ culture based on appropriate education and counseling often resolves many dilemmas, which happen with the clients.

Conflicting Values and Belief Systems

Having analyzed the history, I noticed that both the mother and the father had different values and belief systems despite having been married for two years. The father was a Christian and believed in prayers. However, his religion and upbringing did not affect his health or behavior. Significantly, he had a positive attitude towards seeking medical attention. However, the mother thought that it was better to try alternative means first before attending the hospital. Her family had inculcated that belief in her. Both parents agreed to have never discussed the issue of medical treatment before. I thought that the nurse would consider the scenario as child abuse, but she would rather choose to understand the cultural aspects. Douglas et al. argue that thorough analysis is a fundamental aspect of delivering competent transcultural care.

Missing Data

At first, the mother was reluctant to explain the ‘cao gio’ practice. Later, she provided little information and did not reveal how often she had been doing it when the nurse noticed other chronic scars. She refused to say if such practice had been done to her in her childhood. Furthermore, the mother was not comfortable explaining whether she intended to prioritize medical care over ‘cao gio.’

Culturally Congruent Care

According to Mixer et al., culturally congruent care involves delivering care that considers the values, practices, traditions, and beliefs of the patient. Some patients have racial, gender, ethnic and religious differences, which make them view health and illnesses differently. In this regard, Mixer et al. contend that delivering culturally congruent care ensures patient dignity and promotes compliance with care. The congruent cultural strategies that I recommend for similar cases include the consideration of the patients’ culture when taking the medical history. Additionally, healthcare providers need to treat the patients carefully and ensure that they have consented to the care according to their beliefs.

Conclusion

Consideration of the patients’ culture in the healthcare settings is necessary because they could come from different backgrounds. The case scenario of the ‘cao gio’ shows that culture influences various aspects of life, including marriage and healthcare. The mother provided valid reasons for her ‘cao gio’ implementation, which enabled the nurse to intervene and to help the father understand it. Therefore, when collecting the patient history, nurses need to analyze the background of each person critically and provide appropriate care without condemning the patient. This culturally congruent care can promote understanding among people of different cultures and encourage the patients to comply with the therapeutic medical regimen and nursing care.

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