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Article Excerpt
Goal
To increase understanding of the experiences of Hmong patients on hemodialysis.
Objectives
1. Explain the traditional beliefs of the Hmong culture and how they are related to the health care of Hmong patients.
2. Discuss the experiences of Hmong patients on hemodialysis.
3. Describe nurses' experiences of working with Hmong patients on hemodialysis.
The United States has long been described as a "melting pot" due to its culturally diverse population. This trend continues today, with the Hmong immigrants adding to the diversity since the mid-1970s. The Hmong are some of the most recent immigrants to the U.S. Their homeland has been identified as Laos, Thailand, Vietnam, and Burma (Parker & Kiatoukaysy, 1999). It has been suggested that many Hmong were instrumental in aiding U.S. forces during the Vietnam War and that they were promised safety and shelter by the U.S. when the war ended (Mattison, Lo, & Scarseth, 1994). Many Hmong families fled to the jungles to escape the wrath of the communists (Duff), et al., 2004; Faderman, 1998; Fadiman, 1997; Mattison et al., 1994) and risked their lives attempting to reach refugee camps in Thailand. Living conditions in these camps were horrendous (Faderman, 1994; Mattison et al., 1994; Moore-Howard, 1982). Church groups and individual citizens sponsored Hmong immigrants and agreed to help their transition to American life (Mattison et al., 1994). In the 2000 census, there were 186,310 Hmong in the U.S., with the majority residing in California, Wisconsin, and Minnesota (Hmong National Development, Inc., 2004).
Most Hmong, like other immigrants to the U.S., have unique cultural beliefs and practices that they bring with them. These cultural norms affect their daily life in the U.S., in addition to their beliefs about health, illness, medicine, and healing. These customs may also impact the Hmong's utilization and understanding or acceptance of western healthcare services.
In their homeland, many Hmong experienced acute and chronic illnesses, such as tuberculosis, diarrhea, small pox, and infections. In the U.S., they also experience chronic diseases, such as diabetes, cardiovascular disease, and kidney disease. These disease processes and their accompanying treatments may be new to some Hmong, and it is essential that nurses gain an awareness of Hmong experiences with these conditions in order to provide quality nursing care. Unfortunately, there is a lack of research exploring Hmong experiences with these diseases and their treatment modalities. In particular, end stage renal disease (ESRD) and hemodialysis have not been studied in the Hmong population. Nor has there been an exploration of challenges nurses face while working with Hmong patients on hemodialysis. The purpose of this study was to explore Hmong experiences with hemodialysis as well as the experiences of nurses working with these Hmong patients.
Review of Literature
Traditional Hmong Belief System
According to traditional Hmong view, illness is experienced because of soul loss (Bliatout, 1986; Tapp, 1989; Westermeyer, 1988), natural hardships, environmental events, stress, or spirits that are angry (Westermeyer, 1988); spirits that are unhappy or offended (Reznik, Cooper, MacDonald, Benador & Lemire, 2001); or an accumulation of bad blood (Westermeyer, 1988). This bad blood needs to be removed cautiously because the Hmong believe the human body only has a finite amount of blood to last their lifetime.
The concept of a chronic illness that can be controlled but not cured is traditionally unfamiliar to the Hmong; thus, when the Hmong seek health care, they want their symptoms resolved, usually with medication (Waters, Rao, & Petracchi, 1992). When this does not occur, the Hmong are often noncompliant (Cha, 2003; Johnson, 2002). Traditional methods of healing or treating illness include rituals performed by particular diagnosticians, such as the egg reader, fortune teller, or basket spirit caller (Bliatout, 1991). Non-spiritual healers include the herbalist, massage therapist, and acupuncturist (Blaitout, 1991). Cupping and coining are used as treatment for illnesses that are not severe, but these are sometimes mistaken by western care providers as evidence of abuse (McInnis, 1991). The Hmong might also use special string or chains tied around the wrist or neck to prevent soul loss (Johnson, 2002; Westermeyer, 1988). The shaman is a spiritual healer who can be consulted to help treat some illnesses (Bliatout, 1991). The shaman is believed to be able to communicate with the spirits to assist in healing (Duffy et al., 2004). There is evidence that some Hmong utilize their traditional healing methods as well as current medical treatment available from healthcare providers (Cha, 2003; Culhane-Pera & Lee, 2006; Dhooper, 1991; Moua, 2003; Plotnikoff, Numrich, Wu, Yang, & Xiong, 2002).
Effects of Hemodialysis
There has been extensive research exploring the effects of hemodialysis. Hemodialysis has the potential to affect every aspect of an individual's life: physical, emotional, social, financial, and spiritual (Furr, 1998). Fatigue and emotional exhaustion occur frequently (Chang, Lee, Kim, & Kim, 2003; Hagren, Pettersen, Severinsson, Ltitzen, & Clyne, 2001; O'Brien, 1983). Sleep disturbances and insomnia occur as a result of the disease, treatment, and medications (Curtin, Bultman, Thomas-Hawkins, Waiters, & Schatell, 2002; Gurklis & Menke, 1988; Polaschek, 2003). The ability to perform daily activities is affected (Thomas-Hawkins, 2000) and may even vary with the dialysis cycle (Polaschek, 2003).
Physiological effects from dialysis may produce discomfort and include hypotension, nausea, vomiting, muscle cramps, headaches, loss of muscle tone, and change in skin color (Gurklis & Menke, 1995; Suet-Ching, 2001). Psychological effects include isolation, affecting relationships (O'Brien, 1983); disrupted marital and family life (Hagen et al., 2001); inability to fulfill roles and responsibilities (Gurklis & Menke, 1988); and a loss of control (Moua, 2003). Unemployment and frequent hospitalizations can affect the financial status of a patient on hemodialysis (Gurklis & Menke, 1988).
Methodology
Subject Selection and Description
Following approval from the Institutional Review Boards of the researcher's affiliated institution and hospitals, the entire population of Hmong patients on hemodialysis (N = 7) and registered nurses working in hemodialysis (N = 23) at two medium-sized hospitals (250 beds) in a midwestern city were invited to participate in the study.
Data Collection Procedure
To maximize participation in the study, a respected member of the Hmong community agreed to assist with explaining the study to the Hmong patients on hemodialysis (Polit, Beck, & Hungler, 2001; Shadick, 1993). The translator working with these patients at the hospitals agreed to assist with the interview process. All participants requested to be interviewed during their dialysis treatment. All interviews were tape recorded and field notes were taken. Clarification of misunderstandings or confusing responses was attempted during the interview process, although a structured format was used. Immediately following the interviews, the recordings were transcribed verbatim by the researcher. The field notes were referred to when clarification in the recording of the interview was required. No participant names or other identifying information was recorded.
Data were collected from the nurses working in the hemodialysis units using a questionnaire developed for the purpose of this study. Suggestions by Dillman (2000) were utilized...
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