Name: Necy Tessa C.

Acosta BSN N41

STRATEGIES FOR STRENGTHENING CULTURAL COMPETENCY:

Case scenario: Confronting a Fetal Abnormality

Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to East
Valley Hospital-a large, suburban, non-teaching hospital--with severe cramping. A preliminary ultrasound
indicates brain abnormalities with her fetus. She is accompanied by her husband of eight years (also an
immigrant) and her mother, who speaks no English and lives with the couple. Mrs. Ansari (Leyla) also
speaks very little English, though she does understand some; her husband speaks English better, though
somewhat haltingly. Their primary language is Dari.
Mrs. Ansari is stabilized, and further scans are conducted on the fetus. The physicians soon discern that
the fetus is afflicted with a relatively severe encephalocele; its size and location make survival outside the
womb extremely unlikely. The attending physician, Dr. Fox, is not previously acquainted with the patient,
since any earlier prenatal care she obtained was inconsistent and not at this facility.
Dr. Fox enters Mrs. Ansari's hospital room, where she had been meeting with an Afghan female friend
(who apparently also speaks English reasonably well) while waiting for news of the fetus with her
husband and mother, all of whom appear agitated and anxious. Mrs. Ansari's other children (all girls, ages
2, 5, and 6) are in the outside waiting area, accompanied by an aunt. Before Dr. Fox begins to speak, Mr.
Ansari, noticing a look of deep concern on the doctor's face, asserts that his wife is sick with fear and
anxiety and that she herself would prefer that her husband handle any news of the situation. He requests
that Dr. Fox meet separately with him first, outside of his wife's room. Moreover, it is the traditional time
for Muslims to offer prayers, and, since he and his family are devout Muslims, they would prefer to do so
before any difficult conversations are had with the doctor. Mrs. Ansari, obviously upset but remaining
silent, makes no visible objection to her husband's wishes. The friend also is silent. Mr. Ansari repeats his
request that the doctor meet separately with him.
Dr. Fox, unsure of how to proceed but not wanting to stress Mrs. Ansari further, agrees to meet the
husband separately across the hall, in an empty office; but he also informs Mr. Ansari that they must talk
now, for he does not have time to wait for him to complete his prayers. Mr. Ansari silently follows the
doctor to the empty office, where Dr. Fox discloses the most recent scan results to Mr. Ansari. Dr. Fox
recommends termination of the pregnancy. Stunned, Mr. Ansari sits in silence for several minutes.
After several moments, there is a knock on the door from Mrs. Ansari's mother. She immediately discerns
from the husband's face that something is terribly wrong and asserts (in Dari) that her daughter must not
be told anything of the situation until she is in a better frame of mind. She converses for some time with
Mr. Ansari, becoming increasingly agitated through the course of the conversation. Dr. Fox eventually
interrupts and asks the husband to translate, which he does, relaying that Mrs. Ansari's mother insists that
the medical information from the scans may be faulty, and it would be bad luck for her daughter to learn
the scan results at this point. In fact, she asserts, her daughter may "lose the baby" from stress over the
results. She wishes for the hospital to keep her stable and let the fetus continue to grow inside her uterus
in order to see "what God intends." She herself firmly believes (though there has been no information in
 this regard) that this baby is the long-anticipated boy that the entire family has been hoping for, and that
God would not visit such an unhappy result on such a devout family.
Mr. Ansari then turns back to Dr. Fox and insists that the doctor refrain from telling Mrs. Ansari the scan
results, assuring him that he will tell his wife himself once she is emotionally ready for the news. The
doctor, increasingly frustrated with the direction of the conversation, informs the husband that such a
choice is not his to make. He gets up and proceeds back across the hall, where he walks in on Mrs. Ansari
awkwardly performing her prayers. Dr. Fox interrupts her and asks the friend (who is still present) to help
him translate his news for Mrs. Ansari. He then gently but firmly informs Mrs. Ansari of the scan results,
as the friend awkwardly translates for her. Mr. Ansari has stayed across the hall, and Mrs. Ansari's mother
retreats, wailing, to the waiting room. Mrs. Ansari struggles to keep her tears at bay as she listens to the
doctor.

CULTURALLY COMPETENT CARE PLAN

STEP SELF- CLIENT- CULTURAL CARE GOALS NURSING EVALUATION
ASSESSMENT CENTERED BARRIERS TO ACTION
CULTURAL CULTURALLY
ASSESSMENT COMPETENT
CARE
Prohibiting the Mrs. Ansari's From the moment To prevent in Just allow Mrs. Anari and
patient from mother asserts the family senses contradiction Mrs. Ansari's her family find
speaking in their (in Dari) that her something is beliefs for her Dr. Fox's
Step 1 native tongue daughter must terribly wrong concerning the permitted viewpoint
(Cultural
and making not be told with the long- essential consent for regarding the
Destructiveness)
them to use only anything of the anticipated baby, Muslim belief right not to patient's right
a language that situation until they insist on that "One does know and not to know
is common to she is in a better shielding the not tell bad must accept with informed
everyone. frame of mind. patient from the news, period," that "the consent
bad news for fear as well as the patient's right upsetting.
of its harmful widely held not to know"
impact. Dr. Fox, view among is as valid as
on the other hand, healthcare "the patient's
is a firm believer professionals right to
in Mrs. Ansari's that "Every know."
right to know patient has a
what is wrong right to know."
with her baby.
Christian prayer Mrs. Ansari's
was more mother insists
powerful than that the medical
Muslim prayer information
because from the scans
Step 2
(Cultural
Christian’s may be faulty,
Incapacity) worship God, and it would be
whereas bad luck for her
Muslims daughter to
worship Allah, learn the scan
who is not results at this
 mentioned in the point. In fact,
bible. she asserts, her
daughter may
"lose the baby"
from stress over
the results.
In my view, it is Dr. Fox informs
illegal to Mr. Ansari that
terminate a they must talk
pregnancy now, for he does
Step 3
through any not have time to
(Cultural
Blindness)
method, whether wait for him to
it is a complete his
therapeutic prayers.
abortion or
because of a
fetal anomaly.
I should be Dr. Fox
mindful about interrupts the
interventions or prayer time of
schedules that Mrs. Ansari and
Step 4
might asks the friend
(Cultural Pre-
competence)
cause conflict (who is still
between me present) to help
and the patient him translate his
by asking about news for her.
their practices
and beliefs.
Setting up a Mrs. Ansari’s
schedule for primary
Step 5 monitoring the language is
(Cultural patient that can’t Dari, but she
Competence)
interrupt with can speak very
their little English,
traditional praye though she does
r time. understand
some; her
husband speaks
English better,

Avoiding The Afghan Dr. Fox depends To completely, Interpreter It cause

making female friend of on Mrs. Anari's efficiently, and services may struggle to the
assumptions Mrs. Ansari, friend to interpret understandabl not have had patient.
Step 6 about the who apparently the scan results. y explain to a Dari/Farsi
(Cultural
client just on knows to He does this the patient the speaking
Proficiency)
how they look speak English despite numerous scan results person but
or other aspects well, was the warning signs, and other might have
of their one who relayed such as Mrs. important arranged a
identification, and Ansari's low information. phone
such their informed the English conversation
religious beliefs. scan results for proficiency and or an
her in Deri the significance of interpreter
language. the information specifically
Dr. Fox is going to come
to share with her. speak to Mrs.
Ansari and
her family.