Hmong Culture
In beginning the interview, a consideration to remember is that eye contact is considered rude to Hmong People and that tone of voice and body language are very important; taking too loudly, placing too much emphasis on words, or talking excessively with hands and arm movements can result in noncompliance (Carteret, 2012). As this patient is young and assumed to be mainstream with Western culture, she will likely be understanding and forgiving of eye contact, tone, and body language but interactions with older family members will require care.
Gender of the nurse might play a role in some assessments, it is important to ask if a male nurse has permission to touch the abdomen or auscultate the lungs, heart, or abdomen. Questions pertaining to sex should be private and held with a nurse who is the same gender as the patient, it is of note that questions or examinations regarding sexual health can be misinterpreted as judgment of promiscuity, resulting in refusal, so sex must be addressed with much explanation and rationale without judgment (Carteret, 2012). As infection can be related to sex or sexual contact, this should be addressed with this patient.
The patient’s language preference for the interview is also important. The patient is a young adult and in college, however, her preference might be Hmong, or the language typically spoken at home. Another consideration is, does the patient want anyone else present for her interview/assessment? Hmong People have a family structure that is patriarchal, meaning, the father generally very involved in decision making and can, ultimately have the final say on a topic or treatment; the mother is caregiver and may wish to be present to help take care of the patient. Hmong Elders also play a large role in decision making, with a Grandfather that might want to talk directly with the doctor and make decisions over the wishes of the patient or patient’s father (Carteret, 2012).
Hmong Culture has roots in animism, which is the belief that objects, places, animals, people, etc. all have spirits and bodies that maintain a natural balance (Duffy, J., Harmon, R., Ranard, D.A., Thao, B., & Yang, K. (2004). The fever in this patient could be related to an imbalance in her spirit, an inhabitation by another sprit that is making her ill, disapproval of recent behavior by dead ancestors, or a curse (Carteret, 2012). The family might elect to have a religious healer, or Shaman visit to perform holistic medicine on the patient, some of this medicine might cause burns or pinch marks with coining or skin pinching being common practices for illness (Khuu, Yee, & Zhou, 2017). An understanding of Western medicine might not be present, the patient or family may ask for dosages of antibiotics for infection or acetaminophen of fever to be increase or decrease based on how they feel; it is important to explain that medications are dosed on scientific basis: height/weight, metabolism, excretion, and half-life. In fact, fever should be explained as the elevation in body temperature, generally related to an infection, as the word “fever” can poorly translate into “feeling unwell” or malaise in Hmong (Agency for Healthcare Research and Quality, 2007).
Resources
The hospital system that I work for has language related resources for Hmong patients. During normal business hours, Hmong interpreters can be scheduled or called-in for interviews, assessments, education, etc. so that the patient can have information delivered in their language of preference; these services are for the hospital, clinics, labs, and pharmacies. During off hours, we utilize Stratus Interpreter Services, which is an iPod that allows for audio and/or video interpretation that is considered more personal than the Language Line, or two phone system in which the nurse holds one phone and the patient holds the other with the interpreter interpreting between the two phones.
The Refugee Health Program through the Wisconsin Department of Health Services is another resource for healthcare (Wisconsin Department of Health Services, 2019). Hmong People were instrumental in the Vietnam War, as they were recruited by and fought for the US, becoming refugees and relocating here following the US pulling out of the war effort. This program helps address disparities in healthcare, insurance, etc. that refugees experience to help improve healthcare outcomes.
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