Outcome 7
Outcome seven entails us being able to integrate professional standards of moral, ethical, and legal conduct into the care of persons, families, groups, communities, and populations. Although all of the classes in the BSN program helped contribute to me achieving this outcome, the Transcultural Nursing course and the Policy & Ethics course helped me the most. The Policy & Ethics course was a great platform to open my mind to ethical dilemmas that may occur during the course of my nursing career. We were asked to read and respond to several ethical scenarios. One in particular involved us responding to an ethical dilemma regarding end of life. Another assignment that helped me to achieve this outcome was a discussion about the elderly in nursing homes. This course taught me important ethical principles that I plan to use throughout the rest of my nursing career to give the best care that I can to the people that I care for.
During the Transcultural Nursing course, we had the opportunity to read the book The Spirit Catches You and You Fall Down and write a paper about it. I expected this book to be boring by looking at the cover, but after reading the first few pages I had to keep reading. There were several moral, legal, and ethical dilemmas involving a Hmong family living in American society caring for their daughter having seizures the way they were taught in their Hmong culture while American doctors were treating her condition in a different way. This taught me the importance of respecting and incorporating the cultural values and beliefs of our patients into the care that we give which will in turn help to avoid possible ethical, moral, and legal dilemmas. I know that I will use this valuable knowledge throughout the rest of my nursing career.
End of Life Discussion
I feel that with the question “do patients or families have a moral right to insist on medical treatment that two or more physician and hospitals have deemed futile”, there is not a consistent or plain yes or no answer. This question is complicated and I feel that the answer should be based on each particular situation or case.
The patient does have the right to autonomy and to making their own decisions regarding their health care. Once the patient is unable to make decisions, a surrogate decision maker may act on behalf of the patient and has the authority to make decisions. According to Butts & Rich, “surrogate decision makers sometimes have difficulty distinguishing between their own emotions and the feelings of others or they may have monetary motives for making certain decisions. It is the responsibility of nurses and physicians to be observant for these kinds of motives or concerns and then to look for therapeutic ways to deliberate with the surrogate” (2013, p. 257).
Death is never an easy topic. We must realize that the surrogate has a close relationship with the patient, and is trying to figure out what the best decision would be for them. I think that the nurses and physicians should highly educate the surrogate of the quality of life that the patient will have, as well as the options that are available. The surrogate may just need encouragement and comfort in knowing that it is okay to stop treatment, especially if the patient is suffering.
References
Butts, J.B., & Rich, K.L. (2013). Nursing ethics: Across the curriculum and into practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Elderly Discussion
After reading the assigned text, I think that the biggest way nurses can help to change the experience of residence in a long-term care facility from being like a “living death” is to exercise basic and personal dignity. According to Butts & Rich, “acknowledging elders’ basic and personal dignity, through the adoption of an ethic of dignity, includes the confidence that caregivers will strive to serve the on-going interests of their patients to the best of their abilities” (2013, p. 231).
My first job as a CNA was in a local nursing home. The residents showered on their scheduled day, ate at a specific time, and did not have many choices regarding what they ate. The atmosphere was depressing and I could see how elders would view this type of life as a “living death”. The atmosphere at the next job that I had was completely opposite. The nursing staff would specifically ask the resident when they were admitted if they had any particular preference as to how often and what time of day they showered, and what and when they liked to eat their meals. The recreational therapist made sure to talk with each resident and find out what kinds of activities they enjoyed, she would then make sure to include these activities in her weekly schedule, and would even make special trips to the library or video store to get books and movies that the resident could personally watch or read in their free time. The nursing staff had a positive attitude and showed genuine concern for the patients interests. They truly cared about making the resident their top priority, showing them dignity and catering to their particular preferences and choices. Even if the nurses were stressed or really busy, they took time to talk with each resident. The residents were overall much happier. I believe that this is how nurses should act towards these elders. I believe that if the nurses show dignity and respect to elders, the rest of the staff will see this and have the same caring attitudes making the entire atmosphere more positive and upbeat.
References
Butts, J.B., & Rich, K.L. (2013). Nursing ethics: Across the curriculum and into practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Fadiman Paper
The Spirit Catches You and You Fall Down
In an article written by Wong, Mouanoutoua, & Chen, it states that “Hmong Americans, former refugees from the rural highlands of Laos, have been especially vulnerable to cultural, linguistic, and economic separation from modern and medical systems” (2008, p. 30). The book The Spirit Catches You and You Fall Down is about a Hmong child, Lia Lee, and the experience that she and her family have with her American doctors during the course of her illness. This paper will analyze Lia Lee’s story using Madeline Leininger’s Sunrise Model.
Leininger’s Sunrise Model
Dr. Madeline Leininger’s Sunrise Model is “based on the concept of cultural care and shows three major nursing modalities that guide nursing judgments and activities to provide culturally congruent care” (Andrews, & Boyle, 2012). As quoted by Gebru, Ahsberg, & Willman, culturally congruent care is “tailored to the patient’s cultural values and lifestyle. A patient’s well-being is achieved when health care professional’s decisions and actions are meaningful and supportive of patient’s values” (2007, p. 2058). The Sunrise Model contains seven major cultural and social structure dimensions that influence care expressions, patterns, and practices, and have an impact on holistic health, illness, and death. These dimensions include technological factors, religious and philosophical factors, kinship and social factors, cultural values and life ways, political and legal factors, economic factors, and educational factors (Andrews, & Boyle, 2012). This paper will focus on the cultural and social structure dimensions of the Sunrise Model that influenced Lia’s care. Although important to consider, technological factors will not be discussed, as the other factors had a greater impact on the course of Lia’s care throughout the novel.
Religious and Philosophical Factors & Cultural Values and Life Ways
There were several religious and cultural values the Lee’s possessed that were noted in the book and that played an important role in their view of Lia’s illness and the way they chose to treat it. They believed that the cause of Lia’s condition arose because their older daughter, Yer, slammed the front door of their apartment. Lia jerked, her eyes rolled, and she fainted. “Despite the careful installation of Lia’s soul during the hu plig ceremony, the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as quag dab peg, which means “the spirit catches you and you fall down”” (Fadiman, 2007). In Hmong culture, this illness is considered an honor. Lia’s family believed that she had spirits in her and could one day grow up to be a shaman, one that can interact with spirits during rituals and practice healing.
Due to different cultural values and life ways, the diagnosis of Lia’s condition was seen differently by her parents than her American doctors. Dan, one of Lia’s American doctors had diagnosed her condition as epilepsy. Foua and Nao Kao had diagnosed their daughter’s problem as the illness where the spirit catches you and you fall down. Fadiman writes, “Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia’s parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter’s head that had been stirred up by the misfiring of aberrant brain cells” (2007, p. 28).
Although there were differing views on what Lia’s condition actually was, the medical staff caring for Lia did not take the time to do a proper cultural assessment or try to understand what the Lee’s believed. Of the more than 400,000 words contained in Lia’s chart by the end of her story, not one dealt with the Lee’s perceptions of their daughter’s illness (Fadiman, 2007). Li’s doctors did not incorporate the Lee’s Hmong culture into the medical care plan for Lia, and did not comply with Leininger’s Sunrise Model to achieve culturally congruent care in this particular area.
Only when the medical staff at MCMC was providing supportive care for Lia, assuming that she was going to die soon, did they allow the family to care for Lia with their traditional cultural practices. They allowed the Lee’s to pour a thick, green liquid down her nasogastric tube because they were certain that Lia was going to die anyway. They also allowed Lia’s mother to dress her in traditional clothing on New Years, except for the jacket, because they needed access to Lia’s upper body (Fadiman, 2007).
Educational Factors
Educational factors played a major role in miscommunication and the delivery of non-culturally congruent care. There are several instances in the book where teaching needed to be given to the family regarding Lia’s illness and medication regimen. Foua and Nao Kao spoke the Hmong language and did not know any English. MCMC hospital did not have any interpreters and the only staff member that could translate for Hmong patients was a janitor that spoke Lao, which few Hmong understood. The first few times that Lia was brought to the emergency room, her parents had no way of communicating what was going on with their daughter, leading to misdiagnosis and treatment. Upon discharge from the hospital, they were instructed to sign a paper with information on what medications to take, how often, and when to follow up with the physician. Because Lia’s parents could not read or understand this information, the instructions were not followed and Lia continued to have seizures, repeating the same process over again (Fadiman, 1997).
A big educational factor in this story was the difference and types of educational levels of Lia’s parents and her American doctors. The American doctors that cared for Lia had attended several years of medical school, learning about modern day Western medicine in regards to the human body. Lia’s parents were born and raised in the Hmong culture. By the time Lia was four and a half years old, she had been prescribed over sixteen different medications to take at various times with instructions for the prescriptions changing over twenty times. Although the medication bottles contained instructions as to how much to give and when to take them, Foua and Nao Kao could not read them. Even if the janitor or an English speaking relative were present with the Lee’s while they were being given new medication for Lia, ”they had no way of writing down the instructions, since they were illiterate in Hmong as well as English; because the prescriptions changed so frequently, they often forgot what the doctors told them” (Fadiman, 2007).
Political and Legal Factors
A difference in legal factors in America versus the Hmong culture played an important role in further miscommunication and the delivery of non-culturally congruent care. Since the Lee’s did not understand the instructions given to them regarding Lia’s medication regimen, including how much and how often to give each one, and chose to give more or less of a certain medication based on how Lia reacted to the medication, Lia’s American doctors saw this as negligence and suspected child abuse. The court ordered that Lia be removed from her home and taken into government care. In America, failure to report child abuse is a prosecutable offense. The Lee’s did not know or understand this; they saw the situation as Lia being taken away because her doctors were mad at them and wished to inflict punishment. As quoted by a Hmong interpreter, Koua, “in Laos, the parents have one hundred percent responsibility over the child. How can you say you can take it away unless it is orphan?” (Fadiman, 2007).
There are several examples in the book where the Lee’s are instructed to sign legal documents in which they have no idea or don’t understand what they are signing, but do it anyway so that the medical staff can be in compliance with their paperwork. There were some instances that procedures were done before consent was obtained at all. One specific example is when Lia had her worst grand mal seizure and was transported to Valley Children’s Hospital. A spinal tap was performed on Lia and her father did not hear about it until after it was done. Nao Kao explains, “The doctors put a hole in her back before we got to the hospital; I don’t know why they did it. I wasn’t there yet and they didn’t give me any paper to sign. They just sucked her backbone like that and it makes me disappointed and sad because that is how Lia was lost” (Fadiman, 2007).
Economic, Kinship and Social Factors
The Hmong culture is a very close and tightly knit group. Because of this, the Lee’s had great kinship and social support, as well as additional financial support throughout Lia’s illness. In the beginning of the book, several guests attended Lia’s soul-calling ceremony, most of which were direct relatives to the Lee’s. The economic condition of the Hmong people that had immigrated to America was poor; most did not have jobs or worked in professions that did not accrue much money, and the majority was given money each month by the government. Although they did not have much money to offer, the Lee’s relatives sacrificed and contributed money that they had saved from their public assistance stipends to help the Lee’s afford traditional forms of healing. In addition to contributing money, several relatives of the Lee’s contributed their time as well. One specific example of this is when Nao Kao, his brother, his daughter, his son-in-law and Lia spent three days traveling to Minnesota to visit a famous txiv neeb in hopes to help heal Lia’s condition (Fadiman, 1997). The relatives also spent countless hours caring for the Lee’s other children during Lia’s numerous admissions and time spent at the hospital so that Foua and Nao Kao could be with their daughter. They brought the Lee’s food once a day while they were staying at the hospital, as they could not afford a hotel room or the cafeteria food.
Although the social worker, Jeanine, was not a direct relative of the Lee family, she became close to the family and acted as an advocate for them. She worked hard to obtain disability income for Lia as well as any medical equipment or other needs that were necessary for Lia’s care. She also arranged for the transportation of Lia back to MCMC for supportive care per her family’s request and wishes when Lia was at Valley Children’s Medical Center, and later made arrangements for Lia to return to her home with all of the medical equipment and supplies that were necessary. In addition, all of Lia’s medical bills were paid for by the government. In this area, culturally congruent care was provided.
Conclusion
In relation to Leininger’s Sunrise Model and the care that was given to Lia by her American doctors, there are more instances that culturally congruent care was not provided than instances when congruent care was provided. All cultural and social structure dimensions must be met in order to provide culturally congruent care. As quoted by Fadiman, “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?” (2007, p. 261). By evaluating one’s own cultural opinions and biases, and following Leininger’s Sunrise Model, culturally competent care can be achieved and can help to create overall better health outcomes. It is hard to say, but quite possible, that Lia’s health condition may have resulted in a better outcome if culturally congruent care had been provided in relation to Leininger’s Sunrise Model.
References
Andrews, M.M., & Boyle, J.S. (2012). Transcultural concepts in nursing care (6th ed.). Philadelphia, PA: Wolters Kluwer Health and Lippincott Williams & Wilkins.
Fadiman, A. (1997). The spirit catches you and you fall down. New York, NY: Farrar, Straus and Giroux.
Gebru, K., Ahsberg, E., & Willman, A. (2007). Nursing and medical documentation on patient’s cultural background. Journal of Clinical Nursing, 16, 2056-2065.
Wong, C., Mouanoutoua, V., & Chen, M. (2008). Engaging community in the quality of hypertension care project with Hmong Americans. Journal of Cultural Diversity, 15(1), 30-36.
During the Transcultural Nursing course, we had the opportunity to read the book The Spirit Catches You and You Fall Down and write a paper about it. I expected this book to be boring by looking at the cover, but after reading the first few pages I had to keep reading. There were several moral, legal, and ethical dilemmas involving a Hmong family living in American society caring for their daughter having seizures the way they were taught in their Hmong culture while American doctors were treating her condition in a different way. This taught me the importance of respecting and incorporating the cultural values and beliefs of our patients into the care that we give which will in turn help to avoid possible ethical, moral, and legal dilemmas. I know that I will use this valuable knowledge throughout the rest of my nursing career.
End of Life Discussion
I feel that with the question “do patients or families have a moral right to insist on medical treatment that two or more physician and hospitals have deemed futile”, there is not a consistent or plain yes or no answer. This question is complicated and I feel that the answer should be based on each particular situation or case.
The patient does have the right to autonomy and to making their own decisions regarding their health care. Once the patient is unable to make decisions, a surrogate decision maker may act on behalf of the patient and has the authority to make decisions. According to Butts & Rich, “surrogate decision makers sometimes have difficulty distinguishing between their own emotions and the feelings of others or they may have monetary motives for making certain decisions. It is the responsibility of nurses and physicians to be observant for these kinds of motives or concerns and then to look for therapeutic ways to deliberate with the surrogate” (2013, p. 257).
Death is never an easy topic. We must realize that the surrogate has a close relationship with the patient, and is trying to figure out what the best decision would be for them. I think that the nurses and physicians should highly educate the surrogate of the quality of life that the patient will have, as well as the options that are available. The surrogate may just need encouragement and comfort in knowing that it is okay to stop treatment, especially if the patient is suffering.
References
Butts, J.B., & Rich, K.L. (2013). Nursing ethics: Across the curriculum and into practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Elderly Discussion
After reading the assigned text, I think that the biggest way nurses can help to change the experience of residence in a long-term care facility from being like a “living death” is to exercise basic and personal dignity. According to Butts & Rich, “acknowledging elders’ basic and personal dignity, through the adoption of an ethic of dignity, includes the confidence that caregivers will strive to serve the on-going interests of their patients to the best of their abilities” (2013, p. 231).
My first job as a CNA was in a local nursing home. The residents showered on their scheduled day, ate at a specific time, and did not have many choices regarding what they ate. The atmosphere was depressing and I could see how elders would view this type of life as a “living death”. The atmosphere at the next job that I had was completely opposite. The nursing staff would specifically ask the resident when they were admitted if they had any particular preference as to how often and what time of day they showered, and what and when they liked to eat their meals. The recreational therapist made sure to talk with each resident and find out what kinds of activities they enjoyed, she would then make sure to include these activities in her weekly schedule, and would even make special trips to the library or video store to get books and movies that the resident could personally watch or read in their free time. The nursing staff had a positive attitude and showed genuine concern for the patients interests. They truly cared about making the resident their top priority, showing them dignity and catering to their particular preferences and choices. Even if the nurses were stressed or really busy, they took time to talk with each resident. The residents were overall much happier. I believe that this is how nurses should act towards these elders. I believe that if the nurses show dignity and respect to elders, the rest of the staff will see this and have the same caring attitudes making the entire atmosphere more positive and upbeat.
References
Butts, J.B., & Rich, K.L. (2013). Nursing ethics: Across the curriculum and into practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Fadiman Paper
The Spirit Catches You and You Fall Down
In an article written by Wong, Mouanoutoua, & Chen, it states that “Hmong Americans, former refugees from the rural highlands of Laos, have been especially vulnerable to cultural, linguistic, and economic separation from modern and medical systems” (2008, p. 30). The book The Spirit Catches You and You Fall Down is about a Hmong child, Lia Lee, and the experience that she and her family have with her American doctors during the course of her illness. This paper will analyze Lia Lee’s story using Madeline Leininger’s Sunrise Model.
Leininger’s Sunrise Model
Dr. Madeline Leininger’s Sunrise Model is “based on the concept of cultural care and shows three major nursing modalities that guide nursing judgments and activities to provide culturally congruent care” (Andrews, & Boyle, 2012). As quoted by Gebru, Ahsberg, & Willman, culturally congruent care is “tailored to the patient’s cultural values and lifestyle. A patient’s well-being is achieved when health care professional’s decisions and actions are meaningful and supportive of patient’s values” (2007, p. 2058). The Sunrise Model contains seven major cultural and social structure dimensions that influence care expressions, patterns, and practices, and have an impact on holistic health, illness, and death. These dimensions include technological factors, religious and philosophical factors, kinship and social factors, cultural values and life ways, political and legal factors, economic factors, and educational factors (Andrews, & Boyle, 2012). This paper will focus on the cultural and social structure dimensions of the Sunrise Model that influenced Lia’s care. Although important to consider, technological factors will not be discussed, as the other factors had a greater impact on the course of Lia’s care throughout the novel.
Religious and Philosophical Factors & Cultural Values and Life Ways
There were several religious and cultural values the Lee’s possessed that were noted in the book and that played an important role in their view of Lia’s illness and the way they chose to treat it. They believed that the cause of Lia’s condition arose because their older daughter, Yer, slammed the front door of their apartment. Lia jerked, her eyes rolled, and she fainted. “Despite the careful installation of Lia’s soul during the hu plig ceremony, the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as quag dab peg, which means “the spirit catches you and you fall down”” (Fadiman, 2007). In Hmong culture, this illness is considered an honor. Lia’s family believed that she had spirits in her and could one day grow up to be a shaman, one that can interact with spirits during rituals and practice healing.
Due to different cultural values and life ways, the diagnosis of Lia’s condition was seen differently by her parents than her American doctors. Dan, one of Lia’s American doctors had diagnosed her condition as epilepsy. Foua and Nao Kao had diagnosed their daughter’s problem as the illness where the spirit catches you and you fall down. Fadiman writes, “Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia’s parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter’s head that had been stirred up by the misfiring of aberrant brain cells” (2007, p. 28).
Although there were differing views on what Lia’s condition actually was, the medical staff caring for Lia did not take the time to do a proper cultural assessment or try to understand what the Lee’s believed. Of the more than 400,000 words contained in Lia’s chart by the end of her story, not one dealt with the Lee’s perceptions of their daughter’s illness (Fadiman, 2007). Li’s doctors did not incorporate the Lee’s Hmong culture into the medical care plan for Lia, and did not comply with Leininger’s Sunrise Model to achieve culturally congruent care in this particular area.
Only when the medical staff at MCMC was providing supportive care for Lia, assuming that she was going to die soon, did they allow the family to care for Lia with their traditional cultural practices. They allowed the Lee’s to pour a thick, green liquid down her nasogastric tube because they were certain that Lia was going to die anyway. They also allowed Lia’s mother to dress her in traditional clothing on New Years, except for the jacket, because they needed access to Lia’s upper body (Fadiman, 2007).
Educational Factors
Educational factors played a major role in miscommunication and the delivery of non-culturally congruent care. There are several instances in the book where teaching needed to be given to the family regarding Lia’s illness and medication regimen. Foua and Nao Kao spoke the Hmong language and did not know any English. MCMC hospital did not have any interpreters and the only staff member that could translate for Hmong patients was a janitor that spoke Lao, which few Hmong understood. The first few times that Lia was brought to the emergency room, her parents had no way of communicating what was going on with their daughter, leading to misdiagnosis and treatment. Upon discharge from the hospital, they were instructed to sign a paper with information on what medications to take, how often, and when to follow up with the physician. Because Lia’s parents could not read or understand this information, the instructions were not followed and Lia continued to have seizures, repeating the same process over again (Fadiman, 1997).
A big educational factor in this story was the difference and types of educational levels of Lia’s parents and her American doctors. The American doctors that cared for Lia had attended several years of medical school, learning about modern day Western medicine in regards to the human body. Lia’s parents were born and raised in the Hmong culture. By the time Lia was four and a half years old, she had been prescribed over sixteen different medications to take at various times with instructions for the prescriptions changing over twenty times. Although the medication bottles contained instructions as to how much to give and when to take them, Foua and Nao Kao could not read them. Even if the janitor or an English speaking relative were present with the Lee’s while they were being given new medication for Lia, ”they had no way of writing down the instructions, since they were illiterate in Hmong as well as English; because the prescriptions changed so frequently, they often forgot what the doctors told them” (Fadiman, 2007).
Political and Legal Factors
A difference in legal factors in America versus the Hmong culture played an important role in further miscommunication and the delivery of non-culturally congruent care. Since the Lee’s did not understand the instructions given to them regarding Lia’s medication regimen, including how much and how often to give each one, and chose to give more or less of a certain medication based on how Lia reacted to the medication, Lia’s American doctors saw this as negligence and suspected child abuse. The court ordered that Lia be removed from her home and taken into government care. In America, failure to report child abuse is a prosecutable offense. The Lee’s did not know or understand this; they saw the situation as Lia being taken away because her doctors were mad at them and wished to inflict punishment. As quoted by a Hmong interpreter, Koua, “in Laos, the parents have one hundred percent responsibility over the child. How can you say you can take it away unless it is orphan?” (Fadiman, 2007).
There are several examples in the book where the Lee’s are instructed to sign legal documents in which they have no idea or don’t understand what they are signing, but do it anyway so that the medical staff can be in compliance with their paperwork. There were some instances that procedures were done before consent was obtained at all. One specific example is when Lia had her worst grand mal seizure and was transported to Valley Children’s Hospital. A spinal tap was performed on Lia and her father did not hear about it until after it was done. Nao Kao explains, “The doctors put a hole in her back before we got to the hospital; I don’t know why they did it. I wasn’t there yet and they didn’t give me any paper to sign. They just sucked her backbone like that and it makes me disappointed and sad because that is how Lia was lost” (Fadiman, 2007).
Economic, Kinship and Social Factors
The Hmong culture is a very close and tightly knit group. Because of this, the Lee’s had great kinship and social support, as well as additional financial support throughout Lia’s illness. In the beginning of the book, several guests attended Lia’s soul-calling ceremony, most of which were direct relatives to the Lee’s. The economic condition of the Hmong people that had immigrated to America was poor; most did not have jobs or worked in professions that did not accrue much money, and the majority was given money each month by the government. Although they did not have much money to offer, the Lee’s relatives sacrificed and contributed money that they had saved from their public assistance stipends to help the Lee’s afford traditional forms of healing. In addition to contributing money, several relatives of the Lee’s contributed their time as well. One specific example of this is when Nao Kao, his brother, his daughter, his son-in-law and Lia spent three days traveling to Minnesota to visit a famous txiv neeb in hopes to help heal Lia’s condition (Fadiman, 1997). The relatives also spent countless hours caring for the Lee’s other children during Lia’s numerous admissions and time spent at the hospital so that Foua and Nao Kao could be with their daughter. They brought the Lee’s food once a day while they were staying at the hospital, as they could not afford a hotel room or the cafeteria food.
Although the social worker, Jeanine, was not a direct relative of the Lee family, she became close to the family and acted as an advocate for them. She worked hard to obtain disability income for Lia as well as any medical equipment or other needs that were necessary for Lia’s care. She also arranged for the transportation of Lia back to MCMC for supportive care per her family’s request and wishes when Lia was at Valley Children’s Medical Center, and later made arrangements for Lia to return to her home with all of the medical equipment and supplies that were necessary. In addition, all of Lia’s medical bills were paid for by the government. In this area, culturally congruent care was provided.
Conclusion
In relation to Leininger’s Sunrise Model and the care that was given to Lia by her American doctors, there are more instances that culturally congruent care was not provided than instances when congruent care was provided. All cultural and social structure dimensions must be met in order to provide culturally congruent care. As quoted by Fadiman, “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?” (2007, p. 261). By evaluating one’s own cultural opinions and biases, and following Leininger’s Sunrise Model, culturally competent care can be achieved and can help to create overall better health outcomes. It is hard to say, but quite possible, that Lia’s health condition may have resulted in a better outcome if culturally congruent care had been provided in relation to Leininger’s Sunrise Model.
References
Andrews, M.M., & Boyle, J.S. (2012). Transcultural concepts in nursing care (6th ed.). Philadelphia, PA: Wolters Kluwer Health and Lippincott Williams & Wilkins.
Fadiman, A. (1997). The spirit catches you and you fall down. New York, NY: Farrar, Straus and Giroux.
Gebru, K., Ahsberg, E., & Willman, A. (2007). Nursing and medical documentation on patient’s cultural background. Journal of Clinical Nursing, 16, 2056-2065.
Wong, C., Mouanoutoua, V., & Chen, M. (2008). Engaging community in the quality of hypertension care project with Hmong Americans. Journal of Cultural Diversity, 15(1), 30-36.