Chinese Patient Might Get Worse in an American Hospital - Case Study Example

A Chinese Patient Might Get Worse in an American Hospital There are millions of cultures in the world. Each culture has own beliefs, traditions, language, expectations, responsibilities, morals and customs. When two people from different cultures contact, it might cause conflict. Sometimes the same behavior would be no problem in one culture but very rude or unacceptable in the other culture. Cultural differences in healthcare between China and America may leave Chinese patients confused. Patient expectations might not be met and this will affect their recovery. If a Chinese patient moves to America, the patient’s recovery might be delayed because of stress, doing difficult tasks and not properly understanding the patient’s role. A Chinese postpartum patient gets stressed out when an American health provider judges her with American standards. Postpartum practices vary among cultures. Customs are very clear and specific, and are passed down from generation to generation. Postpartum cares in America are very different from China. A new American mother is expected to learn and to take care of her baby right after the delivery because most households in America are nuclear families. Help is limited compared to the traditional extended family system prevalent in China. Nurses teach the new mother many things about caring for a newborn, such as diaper changing, umbilical cord care, bathing, breast/ bottle feeding and wrapping. The mother is also taught many things about taking care of herself, such as breast care, uterine massage, signs of acute bleeding and perineum care. All mothers receive this training even if it is their second or third child. When a health provider sees the new mother taking care of her baby, the mother is described as “ well bonded with a newborn, ” “very active” or “ a great mother.” Traditional Chinese mothers believe in harmony with nature in value orientation. The two opposite forces, yin and yang, should be balanced in nature as well as the human body. The postpartum period is perceived as coldness, so the mother has to restore her body by eating hot food and resting until fully recovered. The mother is restricted from performing her usual household chores. The resting period is about a month long and is called “doing the month” (Dennis, 2007). In Wang’s study, if Chinese women eat cold food or start activity before a month, they believe they will have chronic pain for the rest of their lives (2009). During the month of rest, the mother stays in bed and tries to make her body warm. She often eats hot soups and hot drinks. Her husband, her mother or other relatives take care of her baby. The patient does not take a shower. Instead, her family provides her sponge baths (Raven,2007). An American health provider seeing this behavior might not understand. The new mother is on bed rest all of the time, drinks hot water even if the outside temperature is over 100°F or she has fever, refuses to apply an ice pack to perineum to reduce swelling, and does not take care of her baby on her own. The new mother is seen as “lazy”, “detached from the newborn” or “uneducated.” The new mother would feel stressed by seeing a healthcare provider’s disapproving facial expressions, or by being pushing to learn about newborn care during hospitalization. A Chinese patient is burdened by making healthcare decisions and accepting new responsibility right away. In America, all people believe they have equal rights and each should have complete control over one’s own destiny. A patient has to know her own health issues, and his/her health information is not disclosed to anyone without his/her permission. A doctor is not supposed to discuss a patient’s health problems with his/her family. Patient rights are under The Health Insurance Portability and Accountability Act of 1996 (HIPAA). If a senior citizen is newly diagnosed with a cancer, a doctor has to tell the truth about the prognosis and likely outcome. The patient has a right to know his health problem, and he is the one who has to make a decision about further plans. Also, many seniors make their health decision by signing an advance health care directive or a power of attorney before they become really ill. Their sons or daughters have no right to change it. Chinese believe the best way to be organized is as a group, where everyone shares in the decision process. In China health professionals discuss a patient’s condition with the patient and the family without the patient’s permission. If a patient has cancer or some serious disease, the doctor talks with his/her family first. Then, the family will talk with relatives to get another opinion. The family will make a final decision whether they are going to tell the truth to the patient or not. In some cases, the family tells the patient that he/she has a minor health problem, and it is curable. The family will hide the truth from the patient for the rest of his/her life. If a patient is hospitalized for treatment, health professionals support the family’s decision so that the patient does not know his/her diagnosis. Everybody sticks to the same story. The family wants to protect the patient from emotional distress. They will discuss options with a doctor, and find the best treatment for the patient. Usually this is a biomedicine or an ethnomedicine. The family members are the one who make all decisions for the patient. Tieying’s study shows that 87% of physicians discuss the patient’s prognosis with family first, and believe that telling the truth to cancer patients is not appropriate (2011). In Jiang’s study, 87.5% of oncology doctors report that patients with early-stage cancer should be told of their diagnosis, but 40.5% of physicians think that patients with terminal illness should be informed of the truth. But, in reality, doctors obey the wishes of the family. Senior citizens that get sick are fragile. Traditional Chinese culture that protects the elderly from emotional and physical hardships has been practiced for thousands of years. Taking care of and protecting the elderly is a Chinese philosophy and tradition. Senior citizens are dependent on their children for many resources such as personal care, healthcare expenses, financial assistance and emotional support (Li, 1999). When the elderly are sick, dependence becomes stronger. Most healthcare decisions are made by their sons. Cancer is still like a death sentence to old people even though medicine and treatment for cancer is very advanced. The elderly believe their lives will be ended shortly if they have cancer. They also worry their healthcare expenses will burden their children. The elderly feel sorry for their children who need to spend extra money for their treatments. Elderly Chinese cancer patients also worry about the emotional stress their illness will cause their children. If a Chinese senior citizen is a patient in America, a doctor will tell him/her directly the truth that he/she has cancer. This elderly person has to deal with problems such as telling their children about the illness, medical expenses, decisions about the treatment, handling their own emotions. These complex tasks might lead the elderly person into emotional or psychological chaos, and make his/her health worse. A Chinese patient’s role is not performed properly in America because of cultural differences. Each culture has its own expectations for a person taking on the patient’s role. Let’s take an example of an American senior, who just had knee surgery. His/her children visit the patient, and ask how he/she is doing. Then, they will leave and go back to their home because they need to go to work next day. They might come back to see the patient on the weekend, or they might call him/her every day. Nurses or nurse’s assistance will help the patient meet his/her needs such as helping with daily hygiene, setting up the table for each meal or giving assistance to the bathroom. Physical therapy will start soon after the surgery. All health providers will encourage the patient to do daily activity, and the patient will follow their instructions. The family has been central to the social organization in China for thousands of years. They believe in the Confucian tradition of filial obligation (Cheng, 2006). Children are willing to sacrifice for their parents. It is not rare that a married son and his wife live with his parents under the same roof (Barusch, 1995). If his father is in a hospital, family members bring food from home and visit him every day or stay with him until he is discharged. They do not want him to do anything by himself during hospitalization. Family members encourage him to stay in bed, and restore his energy. They might feed him, wash his face, cut his fingernails, or clothe him. The family’s role for sick parents is to do everything for the patient in an effort to make them emotionally and physically comfortable. In the patient’s role in China, he/she expects to be taken care of well. The respect and honor for parents and the elderly is an important part in Chinese culture that has been passed down for many years (Chan, 2005). An elderly Chinese patient feels protected and sheltered when receiving care from their children. The patient is completely removed from social responsibilities while recovering. He/she might enjoy getting the care. However, if the patient is hospitalized in America, he/she would not perform the traditional patient’s role. American health providers would push him to do daily activities by himself. They will help the patient to the bathroom, to let him brush his teeth instead of bringing water and a tooth brush to his bed. Cultural competency is required in many hospitals. Misunderstood cultural behavior or attitudes might cause both healthcare providers and patients to become upset. Due to cultural differences, a Chinese patient is perfectly fine in China, but is called lazy, is exposed to unmanageable tasks and is unable to perform the patient’s role in America. Without knowledge of other cultures, American healthcare providers may make their patient’s health worse. Work cited Barusch, Amanda. "Programming for Family Care of Elderly Dependents: Mandates, Incentives, and Service Rationing." Social work 40.3 (1995): 315-22. Chan, Joyce, and Jeanie Kayser-Jones. "The Experience of Dying for Chinese Nursing Home Residents: CULTURAL CONSIDERATIONS." Journal of gerontological nursing 31.8 (2005): 26,32; quiz 52-3. Cheng, Sheung-Tak, and Alfred Chan. "Filial Piety and Psychological Well-being in Well Older Chinese." The Journals of Gerontology 61B.5 (2006): P262-9. Dennis, Cindy-Lee, et al. "Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review." Womens Health 3.4 (2007): 487-502. Jiang, Yu, et al. "Different Attitudes of Oncology Clinicians Toward Truth Telling of Different Stages of Cancer." Supportive Care in Cancer 14.11 (2006): 1119-25. Li, Hong, and Martin Tracy. "Family Support, Financial Needs, and Health Care Needs of Rural Elderly in China: A Field Study." Journal of Cross-Cultural Gerontology 14.4 (1999): 357-71. Raven, Joanna, et al. "Traditional Beliefs and Practices in the Postpartum Period in Fujian Province, China: A Qualitative Study." BMC Pregnancy and Childbirth 7 (2007): 8-. Tieying, Zeng, et al. "Health Professionals Attitude Towards Information Disclosure to Cancer Patients in China." Nursing ethics 18.3 (2011): 356-63. Wang, Xiaoli, et al. "Womens Postpartum Practices and Chronic Pain in Rural China." Maternal and child health journal 13.2 (2009): 206-12. Read More