Emergency Department Waiting Room

This is a discussion post.

Read through the following transcript, and answer accordingly.

The Riverbend City: CAM Mission demonstrates the common reactions of health care providers when faced with the unfamiliar health care practices of various cultures. For your discussion:

• Search the  internet, or journals for information on alternative methods of healing specific to an ethnic group.
• Describe its use today and the influence of this tradition on the medical practices of this population.
• Explain the barriers and challenges associated with caring for individuals who practice complementary and alternative medicine (CAM) and explore how these practices can impact health and wellness. Support your discussion with references to the professional literature.

Your initial posting should be at least 150 words, and you must reference the work of another writer (either as a quotation, paraphrase, or summary) to provide support for your ideas. The source can be the course text, another relevant book, any assigned reading. When you incorporate the other writer’s ideas in your work, use APA citation style to give credit to that writer. Remember that an APA citation includes both the in-text citation (the author’s last name and the year of publication) and the full reference for the source.

Scene 1: RCMC, Emergency Department Waiting Room

Expository Text: Chandra Capshaw, the hospital social worker, and Carl Lauderback, the Emergency Department nurse manager, try to piece together the details behind the marks found on Lue’s back.

Dialogue 01: Jason reacts to the news that RCMC personnel are concerned that Lue has been abused.

Jason:
Are you telling us that you think Lue has been abused? That his parents hurt him? Is that what you people think?

Chandra:
It isn’t a question of what we think, Jason. We’re trying to determine what happened. I think we can all agree that we all want what’s best for Lue.

Bo:
Jason, you have to calm down. You’re frightening Kaying and making things worse. (To Christina) You’re Hmong?

Christina:
Yes, my name is Christina Cha. I work as an admin here, but I am also trained in medical interpreting. I can help get this figured out.

Jason:
We don’t need your help. Just get my cousin and we’ll take care of him ourselves.

Chandra:
Jason, we do need Christina’s help. Child Protective Services has been called in and we need to determine what exactly happened before we can even think about releasing Lue.

Jason:
(Raising voice) You need to just get my cousin and let us get out of here. We never asked you people for help… you don’t have any right to keep him against our will.

Dialogue 02: Hearing raised voices, Officer Kowalski steps in.

Brad:
Okay kid, if you can’t be respectful, you’re going to have to leave.

Jason:
What???

Bo:
Jason, please… we need you here. Please stop making them angry.

Chandra:
Officer, I think we’re alright. Jason was just a little upset.

Carl:
It’s okay Brad.

Jason:
Look… just go get my cousin and bring him here. We’re taking him home.

Bo:
Jason, you have to calm down. We need to go up to the unit and see Lue and find out what happened to him. How badly hurt he is. This isn’t helping.

Jason:
I can’t believe you trust these people more than me. (Kicks trash can)

Brad:
Okay… that’s it, kid. You’re out of here.

Jason:
Get off of me… let me go.

Bo:
No… leave him alone. He didn’t do anything.

Dialogue03: Carl, who has paged Jessica to join them, tries to salvage the situation and find out exactly what happened.

Carl:
Jessica… thanks for joining us.

Jessica:
(Apprehensively) Sure. What’s up?

Carl:
We’re trying to understand what you saw during your assessment of the Vang boy. This is his mother.

Kaying:
(In Hmong… crying) Why can’t I see Lue? Why did the police take Jason away? I don’t understand what’s happening and why you won’t let my family help me.

Christina:
(In Hmong) It’s going to be alright. I will help you and when we tell them why Lue had the marks on his back, I am sure we can get Jason and his mother back to help you. It is going to be alright.

(In English) Carl… Mrs. Vang is very frightened. Can you ask her what you need to ask so she knows what’s going on?

Chandra:
Let me start. You’re ready to interpret for her?

Christina:
Yes.

Chandra:
Mrs. Vang… when the nurse examined Lue, she saw red marks on his back. Can you tell me how those marks got there?

Christina:
(In Hmong) [Mrs. Vang… when the nurse examined Lue, she saw red marks on his back. Can you tell me how those marks got there?]

Kaying:
(In Hmong) [Lue had a cold (mob khaub thuas) …congestion (txhaws ntswg). So, I gave him Hmong remedies. I boiled some Hmong herbs for him to drink, I rubbed him with tiger balm and used a coin to get rid of the bad wind. That was two days ago.]

Christina:
Lue had a cold and congestion. So, she gave him Hmong remedies. She made a tea with some Hmong herbs for him to drink, and then she put tiger balm on him and rubbing his back with a coin to get rid of the bad wind. That was two days ago.

Jessica:
Bad wind? What is that? Do you expect us to believe those terrible welts were made just by rubbing his back with a coin?

Carl:
Jessica… let’s listen to Mrs. Vang.

Chandra:
Carl, I have to admit, I am confused. The boy had bruises on his back?

Carl:
If you haven’t ever seen coining before, it can be shocking.

Christina:
(In Hmong) Chandra said, “I am confused. The boy had bruises on his back? Mr. Lauderback… he is a nurse here… said “If you have not seen coining before, it can shock you”.

Kaying:
(In Hmong) Really? This is so strange. Everyone I know knows what this is.

Christina:
(In English) She said this is strange. All Hmong people know what coining is.

Carl:
It is a very common practice in the Hmong community. Chandra, I examined the boy myself. He does have marks from the coining, but they’re not bruises. In my opinion, there is no sign of abuse. Can we talk to CPS and get them to back off? This boy was injured by his exposure to the chemicals and we need to focus on that… and help his family make the best decisions about his care.

Chandra:
I’ll go talk to them. Christina-can you explain to Mrs. Vang what we’re doing and then bring her up to the PICU? I’ll meet you both up there.

Carl:
Jessica -go up to the PICU and tell them-in person-that the Vangs will be heading up to see Lue.

Jessica:
Sure. Whatever you say.

Scene 2: RCMC, PICU Nursing Station

Expository Text: Having notified Christine Sassman, the PICU nurse manager, that the Vangs will be coming up to see Lue, Jessica stops to speak with two of her colleagues about what has occurred.

Instructional Prompt: Click on highlighted characters to hear their thoughts on complementary and alternative medicine.

Dialogue 04: Frustrated and confused, Jessica asks her colleagues for their opinion on CAM.

Jessica:
Okay, I’ve got to ask you… do you think what that family did to that boy is abusive?

Jill:
It’s hard for me to answer that, Jessica. I’ve seen coining before and I know a lot of people who do it and swear by it.

Jessica:
Oh! You can’t tell me you believe it works?

Candace:
There are a lot of things people do that they swear by that may or may not have any effect. Don’t you think your reaction is a bit strong?

Jessica:
No! No, I don’t! A little boy came into us covered in bruises and I’m going to get my butt chewed because I called Child Protective Services. I feel like I’m practicing nursing in Alice in Wonderland.

Jill:
I understand that; I really do. But from what I understand coining doesn’t really do any harm.

Jessica:
You can’t scrape the skin like that painlessly. They hurt that little boy and nobody seems to care.

Candace:
Jessica, don’t take this the wrong way, but it seems like you’ve already made up your mind about this practice and you don’t want to hear anything different. The fact is there a lot of different kinds of people who live here in Riverbend City. It is different than where you got your training. You went to school in Popeil, didn’t you? There’s not a lot of diversity there and it’s understandable that you’re seeing things here that are unfamiliar. I think you need to try to be a little more open-minded, though.

Jessica:
I don’t think I’m ever going to be open-minded about hurting children. (Sarcastically) Sorry!

Dialogue 05: Jill tries to put the coining episode into a broader context.

Jill:
Jessica… you did have training in complementary and alternative medicine, didn’t you?

Jessica:
No, we didn’t do any of that new age, hippy stuff. Of course I had training in CAM. I just happen to think that the medical profession is getting way too PC. Nobody wants to admit that a lot of this stuff is bogus.

Candace:
I don’t think it’s that cut and dried. Are you saying that Western medicine is the only effective medicine in the world?

Jessica:
At least it’s scientific. Unless I missed the scientific rationale for how rubbing someone’s back raw with a quarter cures a respiratory infection?

Jill:
Hey… there’s no need to take Candace’s head off. She’s just trying to understand where you’re coming from… which seems to be more than you’re doing.

Jessica:
I’m sorry. Like I said I think I’m going to get my butt chewed and it’s already been a bad day. I don’t think I’m wrong here, but I’m going to be expected to hang my head and say I was. It just ticks me off.

Dialogue 06: Uncomfortable with the direction the conversation is taking, Candace offers another perspective.

Candace:
Jessica, look… we have a chapel in the hospital. People pray that their loved ones will get through an illness and a lot of times they do. There’s no science behind that, but I don’t know any nurses who oppose it.

Jill:
On the other hand, I have to admit that Jessica has a point. I mean, we’ve all heard of people who get a cancer diagnosis and go off to some quack doctor in the Caribbean or in Mexico instead of doing chemo that might help them.

Jessica:
Thank you Jill. That’s exactly the kind of thing I’m thinking.

Candace:
Are you putting acupuncture or chiropractors in the same category as quacks who take advantage of desperate people?

Jessica:
Well… why aren’t they the same?

Candace:
Wow. I don’t know what to say. I need to get back to work. I’m sorry you’ve had such a rough day, Jessica, but I’ve got to say, I think you need to work on having a more open mind toward different practices. It’s not all quackery and you’re going to have a hard time getting your patients’ trust if they sense you disrespect their ways and beliefs.

Scene 3: RCMC, Chief Nursing Officer’s Office

Expository Text: Several days after the derailment, Christine Sassman, nurse manager for the pediatric intensive care unit, has told Beatriz and Carl about the conversation Jill Lindner and Candace Hong reported to her. Beatriz calls Jessica in to hear her side and to explain RCMC’s policies on CAM.

Instructional Prompt: Click on highlighted characters to hear their thoughts on this topic.

Dialogue 07: Beatriz explains to Jessica why she has been called into the CNO’s office.

Beatriz:
Jessica, I want to start this conversation by assuring you that this isn’t a witch hunt. You are entitled to your beliefs even when they are not popularly shared. What does concern me though is how we can integrate your beliefs with established hospital policy.

Carl:
I think what concerns me most is that you didn’t talk to me before you put in that call to Child Protective Services. So much could have been avoided with better communication.

Jessica:
I understand that, Carl. When it all was happening, it seemed really important to just make that call as soon as possible. But you know… I hadn’t even been planning to call them. I was told… and I don’t want to name names here… but I was told that I had to report it immediately. I thought I was doing the right thing.

Beatriz:
That makes sense. You understand, though, that in the future you should check with a more senior nurse and not act on your own like that?

Jessica:
I do.

Carl:
The other issue that we want to talk about is what appears to be an animosity on your part toward alternative medicine.

Christine:
Two of my nurses mentioned to me-independent of one another-that they were concerned that your attitudes toward alternative medicine created a barrier that could have negatively affected our ability to treat the Vang boy. That’s my concern. What we feel personally toward any particular practice… coining or chiropractic or even something as simple as taking lots of vitamins… shouldn’t get in the way of the relationships we need to build with our patients and their families.

This is important in pediatric nursing, and it’s also particularly important with people who come from certain cultures. For Hmong people, medical decisions are often made by the extended family. Some of the extended family members are going to be more traditional or even old-fashioned. If we can’t respect their beliefs even when we don’t agree with them, were going to have trouble working together for the best outcomes. Does that make sense to you?

Jessica:
Yeah… it does. This is really hard for me because I don’t want to be a racist or anything, but some of the practices I’ve heard about-particularly for the Hmong and Somali people… well the truth is that I don’t really respect those practices. I respect the people… I mean they’re my patients, but I don’t respect sacrificing chickens or believing that evil spirits cause mental illness.

Carl:
That’s fair enough but what you have to focus on is respecting the person and the culture even if you don’t accept particular beliefs.

Beatriz:
Jessica, Shannon Moe recently sent out a link to an online tutorial on this subject. I’d like you to be sure to do it and then make some time to talk with Carl about your results.

Dialogue 08: Carl offers Jessica some advice and encouragement.

Carl:
I think if you focus on the idea of understanding rather than agreeing with various practices, you’ll have an easier time with this. One of the big things for me is understanding why a patient might turn to alternative medicine and treatments. The more we understand motivations, the better we’ll be able to advise our patients.

Beatriz:
The other thing is that some complementary treatments can be very beneficial. Relaxation techniques have been use to help with pain management. Fish oil is one of our tools for fighting high cholesterol.

Jessica:
I understand that… but… and I’m not trying to beat a dead horse, but there’s science behind both those things you mentioned. All through my training, evidence-based practice has been the end all and be all… except when it comes to this topic.

Christine:
We’re getting back to the idea that you have to endorse alternative practices. That isn’t the case. You just need to know what they are and know which treatments your patients might be turning to.

Carl:
You’re right though… we don’t want to beat a dead horse. Do the tutorial and we’ll talk again. And relax… we’re not trying to make you into a Stepford nurse. We just want to help you do the best job possible for your patients.