• Case Study #1
    Carol, a 35-year-old woman of African descent, comes to the clinic for a follow-up
    visit after having an HIV test. Upon receiving her results through the post-counseling
    interview, it is discovered that Carol is really Carl, a 35-year-old man who has
    recently been released from prison.
    Further discussion reveals that Carl participated in receptive anal sex while he was
    incarcerated. When asked about his sexual orientation, he insists he is heterosexual
    and goes on to explain that now that he is HIV positive he can never return to his
    native country in the Caribbean because of the stigma attached to HIV/AIDS.
    He gives a series of expressions in Patois (dialect of English) that would be used to
    describe a person like him and what would be done to such a person. Clearly, Carol
    is  dealing  with  a  series  of  issues  that may  pose  a  challenge  to  the  health  care
    Discussion Questions
    1. As a health care professional, what can you do to increase your
    understanding of  this patient’s culture so that you can get this patient into
    2. How can you find out the meaning of the Patois expressions to better
    understand  this patient’s issues and provide appropriate medical care?
    3. Discuss other Cultural Competence issues that may impact retention into care and
    Case Study #2
    Carmen, a 17-year-old Latina, shows up at a clinic for a gynecological exam.
    Carmen has been sexually active for over a year, and because she does not use
    condoms consistently, she is afraid that she may have contracted HIV or another
    Carmen’s mother has insisted on accompanying her to the exam, which she
    believes, is only to discuss an irregular menstrual cycle that Carmen has been
    complaining about. When the provider asks Carmen if she would like her mother to
    stay for the exam, her mother says, “Of course she would, she has nothing to hide
    from me.”
    As the provider begins to ask Carmen questions related to her sexual health, it
    becomes obvious that Carmen is uncomfortable answering the questions in front of
    her mother.
    When the provider asks if Carmen has ever engaged in sexual intercourse, Carmen
    glances over at her mother and then responds, “No, of course not.” Carmen
  • desperately wants to voice her concerns about the possible contraction of HIV or
    another disease but she is ashamed to admit to her mother that she has been
    sexually active, and therefore does not request the appropriate medical screenings.
    Discussion Questions
    1. What cultural beliefs and values contribute to Carmen’s unwillingness to
    admit her sexual behavior in front of her mother?
    2. How could the health care provider request that Carmen’s mother leaves the
    exam room without offending her or implying that Carmen is hiding something
    from her?
    3. How could the provider successfully address Carmen’s health concerns and
    provide Carmen with sexual health information without causing a great amount of
    family discord between Carmen and her mother?
    4. Discuss other Cultural Competence issues that may impact retention into care and
    Case Study # 3
    • A Vietnamese woman was rushed to the hospital by her adult children. The
    emergency room personnel discovered dark red welts running up her arms,
    shoulders and chest, yet the only presenting complaint was dizziness. When
    questioned, her son explained that he had rubbed her body with a quarter. A
    nurse becomes concerned when she finds an elderly Chinese patient rubbing
    himself with a quarter (she thought he was trying to hurt himself). When she took
    the coin away from the patient, he became very upset, grabbed it back from her
    and continued to rub his arms and legs, leaving dark red scratches.
    • A Vietnamese girl in her first year at an American elementary school was not
    feeling well one morning, so her mother rubbed the back of her neck with a coin.
    When the school staff discovered the welts on the girl’s neck, they immediately
    assumed they were seeing a case of child abuse and reported the family to the
    In each case the patient was practicing a traditional form of healing known as coin
    rubbing. There are several variations, including heating the coin, but they all involve
    vigorously rubbing the body with a coin. This produces red welts, which can distract
    medical staff from the real problem of treatment or be mistaken for child abuse. It is
    important to recognize and become familiar with this practice, and not to be
    distracted from the real problem or mistakenly make accusations of child abuse.
    • Discuss other Cultural Competence issues that may impact retention into care and
  • • Examine and identify the gaps of care/treatment
    • From a “big picture” perspective (administration) what could be
    implemented to ensure cultural competency is being implemented?
    • How could this be handled better using cultural humility and sensitivity?
    Case Study #4
    Kerry, a 32-year-old Native American woman from a small reservation in Montana
    presented to a large urban clinic in the Northwest for care. She was married at age
    17 and had contracted HIV from prior IVDU (intravenous drug use). She has been
    unemployed for the past 10 years. Her husband, Carlos, a Central American
    immigrant, had been HIV tested and was negative, although Kerry admitted they
    occasionally had unprotected intercourse.
    Her medical history was complicated by periodic alcohol and crack binges, and
    a  history  of  abnormal  Pap  smears.  Her  family  and  social  history  revealed
    childhood physical and sexual abuse, and chemical dependency.
    Although she had a brother living nearby in the city, she was adamant that he and
    family in Montana know nothing about her diagnosis or treatment as she feared
    family revenge.
    She did not want her family to try to take her back to the reservation – a place she
    escaped from and she made it clear she didn’t want to return, even after death. Her
    husband agreed with her decision not to return to the reservation, and noted that
    her family did not like him, as he was an “outsider.”
    Kerry knew that her brother Mike often called the primary care doctor for updates
    on her condition. The patient reminded her physician that she wanted her diagnosis
    kept confidential, even if that seemed harmful to others.
    She was initially started on antiretroviral therapy, but frequently missed
    appointments for medical and gynecological care. She occasionally spoke of wanting
    to see a medicine person through the clinic, but did not follow through on this
    because the healer was male, and because she occasionally needs drugs.
    Her CD4(a type of cell to help with immunity) counts continued to decline, with
    rising viral load, and she was admitted to the hospital’s intensive care unit with
    opportunistic infection and cardiomyopathy.
    She had previously expressed a strong desire to be a “no code,” but suddenly
    changed her mind in the ICU(intensive care unit) just prior to her death. After her
    death, her brother and elder aunt demanded to know her diagnosis. Then they told
    her husband that “they were her blood family, and she
  • needed to be buried at home,” regardless of her wishes, and that he had no
    legal or other rights to make any decisions.
    Discussion Questions:
    1. What are the barriers to care in this case?
    2. What ethical decisions must the health care providers make concerning
    her diagnosis and treatment
    3. What course of action could the health care providers have taken for
    more culturally competent care?
    4. How can the issue of her burial be resolved?
    5. Discuss other Cultural Competence issues that may impact
    retention into care  and treatment.
    Case Study #5
    A middle-aged Chinese patient refused pain medication following cataract
    surgery. When asked, he replied his discomfort was bearable and he could
    survive without any medication. Later the nurse found him restless and
    uncomfortable. Again the nurse offered pain medication. Again he refused,
    explaining that her responsibilities at the hospital were far more important than
    his comfort and he did not want to impose. Only after she firmly insisted that the
    patients comfort was one of her most important responsibilities did the patient
    finally agree to take the medication.
    Things to Consider
    ·Chinese are taught self-restraint. The needs of the group are more
    important than those of the individual.
    ·Another factor that may be involved in Asian’s refusal of pain medication is
    courtesy. They generally consider it impolite to accept something the first
    time it is offered.
    ·The safest approach for the nurse is to anticipate the needs of an Asian
    patient for pain medication without waiting for requests – Nurses should be
    aware of Asian rules of etiquette when offering pain medication, food or
    other services.
    · If the patient continues to refuse medication, their wish should be respected.
  • 1. Discuss other Cultural Competence issues that may impact retention into care
    and treatment.
    2. Identify the gaps of caring for the patient in a culturally sensitive manner.
    3. As a healthcare provider how would you have handled this situation in using cultural

The text book is cultural diversity in health and illness ninth edition by

Rachael E Spector

All papers are written by ENL (US, UK, AUSTRALIA) writers with vast experience in the field. We perform a quality assessment on all orders before submitting them.

Do you have an urgent order?  We have more than enough writers who will ensure that your order is delivered on time. 

We provide plagiarism reports for all our custom written papers. All papers are written from scratch.

24/7 Customer Support

Contact us anytime, any day, via any means if you need any help. You can use the Live Chat, email, or our provided phone number anytime.

We will not disclose the nature of our services or any information you provide to a third party.

Assignment Help Services
Money-Back Guarantee

Get your money back if your paper is not delivered on time or if your instructions are not followed.

We Guarantee the Best Grades
Assignment Help Services