Creating culturally competent health care organizations

Mrs. Li Huan, a 79-year-old Chinese American widow who lives alone in New York City’s Chinatown recently had a cerebrovascular accident (CVA) or stroke. Mrs. Li has right-sided paralysis with partial loss of voluntary movement and sensation in her right arm and leg. Mrs. Li has weak facial muscles, difficulty with speech, and drooling. She experiences numbness and tingling in her arms and legs. Mrs. Li is going to a rehabilitation center known for delivering culturally competent interprofessional care where she is cared for by a team of credentialed health care providers: Dr. Indira Patel, nurse J.J. Johnson, physical therapist Mohammad Abu Said, dietician Maria Gonzalez, and Chinese American herbalist, Chen Minzhe.

(Note: In traditional Chinese culture, a person’s last name or surname is written first, followed by his/her first name. Therefore, the patient’s last name is Li and the herbalist’s last name is Chen. It is proper etiquette to call a person of Chinese background by his/her title, in this case, Mrs. Li and Mr. Chen until the individual gives you permission to use his/her first name. To further confuse matters, many acculturated Chinese Americans are likely to reverse their first and last names in the typical US or Canadian order. Therefore, it is important to ask the patient, “What is your first name? What is your last name?” Note the correct order on the patient’s chart for other members of the team.)

1. How do members of the interprofessional team assess Mrs. Li’s literacy, diet, and medications, including herbal medicines being provided by her herbalist, Mr. Chen?
2. How do the nurse and other members of the team determine if complementary or integrative treatments, such as medicinal herbs, are helpful, harmful, or neutral to Mrs. Li’s recovery?
3. If you were seeking advice or consultation from a traditional Chinese herbalist in your community, how would you locate one?
4. Why do patients seek treatment from alternative and integrative healers?
5. How can credentialed health care providers work collaboratively with Mr. Chen to ensure that prescription medicines and herbs are compatible and that there are no adverse or harmful interactions between various medicines?
6. What strategies would you recommend to promote Mrs. Li’s optimum functioning and health following her CVA? (Andrews & Boyle, Transcultural Concepts in Nursing Care, 7th Edition).