(1) citation reference 150 words  Culture Hmong Culture Considerations 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 scientifi.

1. (1) citation reference 150 words
Culture
Hmong Culture
Considerations
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

2. 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,

3. 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.
References
Agency for Healthcare Research and Quality (2007).
Communicating with your Vietnamese patient. Cultural Clues.
Retrieved from
http://depts.washington.edu/pfes/PDFs/VietnameseCultureClue.
pdf
Carteret, M., (2012). Providing healthcare to Hmong patients
and families. Dimensions of Healthcare. Retrieved from
https://www.dimensionsofculture.com/2012/01/providing-
healthcare-to-hmong-patients-and-families/
Duffy, J., Harmon, R., Ranard, D.A., Thao, B., & Yang, K.
(2004). The Hmong: an introduction to their history and culture.
Culture Profile, (18).

4. Khuu, B.P., Lee, H.Y., & Zhou, A.Q. (2018). Health literacy
and associated factors among Hmong American Immigrants:
addressing the health disparities. Journal of Community Health,
(43), 11-18.
Wisconsin Department of Health Services (2019). Refugee
health program. Retrieved from
https://www.dhs.wisconsin.gov/international/index.htm
(2) Reply 150 word reference and citation
Culture
Cultural practices and religious beliefs are the fabric of on
which individuals determine the nature of their lives, shape
their behavior, and take actions with respect to health and
illness. These beliefs and practices are the foundation for
accepting or rejecting various forms of nursing interventions,
and formulating views on tenets of care, including uptake and
use of self-care options. This sensitivity should not only focus
on nursing care interventions but also in the manner which
communication between the healthcare provider and the patent
is carried out (Hordern, 2016) .The purpose of this paper
therefore is to discuss the important issues to put into
consideration when delivering care to a Hispanic 19-year old
female college student who is to be admitted into a hospital for
fever, and the necessary support structure for such a patient.
Considerations
The patient is from a traditional Hispanic home. She has been

5. raised based on a value system that is shaped by both cultural
and religious affiliations of this ethnic community. The
implication of this is that the manner in which she will approach
her illness, respond to it and be willing to open up will be
governed by Hispanic cultural practices and religious beliefs
(Sobel & Sawin, 2016). It is therefore important to be aware of
a wide variety of issues when interviewing this patient. The
first is the belief that loyalty to one’s extended family is more
important than an individual’s needs and wellbeing as outlined
in the practice of
familismo.
Owing to this practice, a Hispanic patient will rely on
direction, advice, and encouragement from members of their
family and are likely to directly involve them in any decision,
including one involving their admission (Handtke, Schilgen, &
Mösko, 2019). In considering
familismo,
I will consider the need for the patient to reach out to their
parents or siblings for emotional support and their need to
involve them in discussing admission, options of treatment,
acceptance or rejection of various medications, among other
treatment options. In addition to this, it is important to note that
women, within Hispanic families, serve as the primary
caretakers. They are highly knowledgeable on family health and
are often able to provide information that may be useful in
developing an accurate diagnosis (Handtke, Schilgen, & Mösko,
2019). Apart from the above, it will be important to consider the
concept of
personalismo.
This is a concept in which Hispanic patients believe that care
delivery can only be successful if they develop a relationship
that is personal with their caregiver. As such, I will show
genuine interest in this patient in order to open up about their
condition. Should the patient fail to develop such a relationship,
they will tend to hold back with the consequence being poor
nursing care (Schmidt, 2019).

6. Resources
The biggest challenge with the delivery of healthcare services to
Hispanic populations within the United States has been limited
access to care owing to language barrier and low economic
status (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis, &
Escamilla-Cejudo, 2016). The support system in my community
has focused on increasing access to care by minimizing
language barrier. Policies that ensure that nurses who are fluent
in understanding and speaking Spanish and English are always
present when care is being provided to Hispanic patients, have
been developed. Additionally, health promotion and health
education materials targeting this group have been designed in a
language that they can understand. Serving a diverse community
requires delivery of culturally sensitive care. Such care requires
understanding of cultural concepts that affect the health
behaviors of such communities such as
familismo
and
personalismo
within the Hispanic community. It also requires developing
support systems within the community to increase access to
quality nursing care.
References
Handtke, O., Schilgen, B., & Mösko, a. M. (2019). Culturally
competent healthcare
– A scoping review of strategies implemented in healthcare
organizations and a model of culturally competent healthcare
provision.
PLoS One, 14
(7), e0219971.
doi:https://doi.org/10.1371/journal.pone.0219971

7. Hordern, J. (2016). Religion and culture.
Medicine (Abingdon), 44
(10), 589-592. doi:10.1016/j.mpmed.2016.07.011
Schmidt, K. (2019). How Do I Best Provide Spiritual Care to
Hispanic Patients?
Journal of Christian Nursing, 36
(2), 125. doi:10.1097/CNJ.0000000000000595
Sobel, L. L., & Sawin, a. E. (2016). Guiding the Process of
Culturally Competent Care With Hispanic Patients: A Grounded
Theory Study.
Journal of Transcultural Nursing, 27
(3), 226–232. doi:https://doi.org/10.1177/1043659614558452
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G.,
Davis, D., & Escamilla-Cejudo, &. J. (2016). Hispanic health in
the USA: a scoping review of the literature.
Public Health Reviews volume, 37
(31). doi:https://doi.org/10.1186/s40985-016-0043-2