Case Study No.

Situation

Mrs. N. and her family had recently immigrated from Cambodian. Mrs. N. had suffered
from severe rheumatoid arthritis and was receiving Methotrexate injections at home.
Home health staff could not communicate directly with her because of a language
barrier, but they could and did rely on Mrs. N.'s son to translate. However, his
command of English was limited and he was not knowledgeable about medical
terminology or procedures. Over time, it was determined that Mrs. N. needed a hip
replacement, and should to come into the clinic for preoperative visits and teaching. For
reasons that were unclear at the time, Mrs. N. failed to keep her appointments.

Cross-Cultural Assessment Findings

In an effort to understand more about this patient and why she was failing to keep clinic
appointments, with the help of her son, the cross-cultural assessment questions were
asked. It was learned that because Mrs. N. was such a recent immigrant, having come
from a very isolated, rural Cambodian farming community, she had no knowledge of
surgery being used to treat a problem such as hers. She distrusted what the physicians
wanted to do because she understood nothing about hip replacement surgery. In her
rural community, surgery was performed only under dire, life-threatening
circumstances.

Interventions

When this information became known, a meeting was held with Mrs. N., her son, key
clinic staff, and the home health nurse. Mrs. N. and her son were helped to understand
that while surgery of this nature was unknown to them, the procedure was frequently
used to help arthritic patients and that staff anticipated a successful postsurgical
outcome. Staff worked with the son to help him understand the necessary technical
information so that he could properly translate information.

Outcome

Within a short time, the surgery was agreed to and scheduled. The home health nurse
made a pre-op visit and later followed through with Mrs. N.'s home care. Mrs. N.'s
progress and outcomes were significantly different because staff asked the right
questions and were sensitive to cross-cultural needs.

 
Case Study No. 2

Situation

Following surgery, an elderly male Filipino patient diagnosed with dementia (Mr. L.)
was referred to home health for wound care. His command of English was quite good;
however, the patient was extremely upset and confused during the nurse's initial visit.

The family had no notion as to why their grandfather was so profoundly agitated. The
nurse decided that another nurse should be assigned to follow the patient's progress. A
different nurse was sent out on the next home visit. Once again, Mr. L. became
increasingly disturbed, confused, and combative.

Cross-Cultural Assessment Findings

Among the cross-cultural assessment questions asked of the family was what they
thought should be done and how Mr. L. should be treated. Family members were at a
loss to understand, but were very concerned because the wound care was complex and
they were not equipped to manage the care themselves. After a third nurse was turned
away, the family and home health agency sat down to problem solve. No one was certain
whether the ethnic background of the nurses was an issue for this patient; however,
everyone present in the conference decided it was worth trying one final approach.

Intervention

A Filipino nurse was sent to care for Mr. L. and the atmosphere changed immediately.
Mr. L. became significantly less agitated and home care resumed. Although his thoughts
were still quite confused because of dementia, he was more at ease with this new nurse.
It was later learned that when non-Filipino nurses came into the home, Mr. L. thought
he was back in the jungles of the Philippines fighting in the second World War. The
presence of a Caucasian face triggered Mr. L.'s combative reactions and heightened his
confusion.

Outcome

In this instance, the nature of the problem was not directly related to differences in
cross-cultural expectations. However, by being receptive to trying different approaches
related to cross-cultural dynamics, the home health department and family were able to
partner to resolve the crisis.