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Nursing Clinical Rounds: Providing Holistic Care for Immigrant Patient

Nurses are more than caregivers—they are educators, advocates, communicators, and collaborators. In providing basic care and comfort, nurses apply a holistic lens to assess, prioritize, and respond to patient needs. Whether addressing the comfort of a chronically ill patient, communicating with a client from a different cultural background, or planning a thorough health assessment, nurses must integrate clinical knowledge with critical thinking, cultural competence, and therapeutic communication skills.

Mr. Phouvong Chanthavong, a 61-year-old recent Laotian immigrant, is admitted to the hospital with pneumonia and newly diagnosed type 2 diabetes. He speaks little English. His daughters are bilingual and often translate for him. Mr. Chanthavong appears disoriented during your shift, frequently declines hospital meals, and shows signs of dehydration and fatigue. His chart shows a temperature of 100.8°F, glucose level of 248 mg/dL, and mild pedal edema. His weight is down 4 lbs from last week. He seems reluctant to ask questions and frequently looks to his daughters for answers.

???? Discussion Prompt
Choose ONE of the following categories and respond thoroughly:

1. Holistic Assessment and Prioritization
Identify which components of the health assessment (physical, psychosocial, cultural) are most important in this case.
How would you prioritize Mr. Chanthavong’s needs using the nursing process?
What basic care and comfort needs should be addressed immediately?
2. Culturally Competent Communication
How can you demonstrate therapeutic communication techniques that also respect Mr. Chanthavong’s cultural beliefs (Dudek Ch. 11, Taylor Ch. 5)?
What role does family involvement play in assessment and decision-making?
Give examples of nontherapeutic communication to avoid.
3. Promoting Health Despite Chronic Illness
How can Mr. Chanthavong be supported to achieve a sense of health even with chronic illness (diabetes and pneumonia)?
What teaching strategies could address his nutritional needs and cultural preferences (Taylor Ch. 9)?
How would you evaluate the effectiveness of nursing interventions related to comfort, hydration, and communication?

What role does family involvement play in assessment and decision-making?

For many Laotian families, health care decision-making is often a collective and hierarchical process, not purely individualistic. Mr. Chanthavong looking to his daughters is a strong sign of this:

Translational and Contextual Role: The daughters are not just translating words; they are translating meaning and culture. They can filter medical jargon and explain concepts in a way that aligns with their father's worldview.

Shared Decision-Making: The family unit (often the eldest children or a consensus among them) may be the primary decision-maker. The nurse must direct questions to Mr. Chanthavong first to respect his autonomy but then actively seek input and consensus from the daughters: "Mr. Chanthavong, do you have any concerns about this medication?" followed by "Daughters, given your knowledge of your father, what are your thoughts on this new diet plan?"

Sample Answer

Culturally Competent Communication for Mr. Chanthavong

Mr. Chanthavong's case presents complex challenges rooted in his limited English proficiency, immigrant status, and cultural background, all of which are compounded by his acute illness (pneumonia) and new chronic diagnosis (Type 2 Diabetes). Effective nursing care requires communication that is both therapeutic and culturally competent.

How can you demonstrate therapeutic communication techniques that also respect Mr. Chanthavong’s cultural beliefs?

Therapeutic communication techniques must be modified and applied with a high degree of cultural sensitivity to establish trust and gather accurate assessment data (Dudek Ch. 11, Taylor Ch. 5).