Case Study 3

Caring for Asian Children Resource

eCALD Supplementary Resources

The following case study illustrates how a nurse applied culturally appropriate techniques to resolve a cultural conflict with the mother of a child who was admitted to the Emergency Department with high fever and was practicing the traditional “coining treatment”. The case study provides a question for viewers to consider and reflect on.

Case Study 3: Coining- Resolving cultural conflict through negotiation (Vietnamese)

(Campinha-Bacote, 2011)

case study iconMrs Lee is a 28 year old Vietnamese woman who brings her daughter, Leah (age 2 years) into the Emergency Department because “she is sick.”

A nurse assesses the child and notes that she has an elevated temperature (39.4° C) with slightly pulse and respirations. After a nursing assessment and diagnostic workup it was found that Leah had a bacterial infection that required an antibiotic. On physical examination, the nurse is concerned to see several symmetrical, striated, and abrasive marks on the back of the child. She is concerned that this may be child abuse, and also that the skin breaks may complicate the child’s bacterial infection.

The nurse asks Mrs Lee how the child received these marks and the mother readily responds, “I did it.” To rule out potential child abuse, the nurse takes a patient-centred approach and conducts a cultural assessment.

First, the nurse asks Mrs Lee to explain what she thought was wrong with her daughter Leah.

Mrs Lee says, “She was very hot and crying and I brought her here because I want her to get all the help she can to get better fast.” The nurse then asks Mrs Lee what kinds of treatments she has tried for this problem. Mrs Lee becomes very defensive and asks, “Why are you asking me all these questions.” The nurse responds by saying that she wants to learn more about Leah and how she is cared for. Mrs Lee reluctantly states, “I used cao gio; I think you call it coining in English.

Although, the nurse has heard and read about the practice of coining among Southeast Asian peoples, she clarifies with Mrs Lee, her understanding of her values, beliefs, and practices. She asks Mrs. Lee to explain coining. Mrs Lee responds, “I get some oil and rub Leah’s back with it and then I rub a small coin down the middle of her back until I see a little blood under the skin.”

The nurse further asks what is/are the expected result or results of coining. Mrs Lee adds, “Coining takes away the wind that is causing her fever.”

Next, the nurse asks Mrs Lee if she has sought help or advice from people other than healthcare professionals, such as people from her community.

Mrs Lee answers, ”Yes! There is an elder in our community who sells the oil for the coining. I think he says it has winter green, or eucalyptus, or peppermint oil in it. I really don’t know, but my family trusts him.” After conducting this cultural assessment the nurse feels confident that the marks on Leah’s back are not child abuse, but rather the culture-specific practice of coining.

The nurse continues the cultural assessment by explaining her perception of Leah’s problem to Mrs Lee.

The nurse explains that Leah has an infection that needs to be treated with antibiotics and that any open wounds can increase the chance of the infection getting worse. Further, the nurse remarks that she is concerned that the skin abrasions caused by the coining may increase the chance of more infections. Mrs Lee abruptly interrupts the nurse and remarks, “I am not going to stop my coining! She won’t get better if we just give her your medicine!” The nurse demonstrates respect for Mrs Lee and acknowledges the differences between their two perceptions regarding treatment of Leah’s illness by telling her that the coining is being done to help Leah and that their common goal is to get Leah better.

The nurse focuses on recommendations that involve Mrs Lee as an active participant in negotiating a mutually acceptable treatment plan. Mrs Lee is firm in the belief that coining is the only way that Leah’s fever will go down. After several recommendations by the nurse and several non-acceptances of these recommendations by Mrs Lee, they finally agree that in addition to complying with the nursing and medical discharge plan, Mrs Lee can rub the coin lightly on Leah’s back, making sure not to cause any redness, bleeding, or break in the skin. Mrs Lee states, “I’ll give this a try.”

Identify the culturally appropriate techniques that the nurse used to resolve the cultural conflict with Mrs Lee without compromising medical and nursing guidelines?