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    who had recently immigrated to the United States from India. She was in the hospital to give birth. Her support person was her sister, Marala. Marala kept telling her to get an epidural, but Amiya said that even though she would like one, she could not get one; her husband would not allow it. Cindy, her nurse, overheard the conversation. Having learned that husbands are the authority figure in the traditional Indian household, she went to speak with Mr. Nidhi. She explained why an epidural would be advisable. She said that he seemed pleased that she came to him about it. He said he would think about it, and let her know.

    Write a 2- to 3-page paper (page count does not include title or reference pages) that addresses the following:

    1. What is the issue from a cultural perspective?
    2. Identify the 4C’s of culture to this case study (The 4C’s of Culture).
    3. What would have you done differently? Why?
    4. What responsibilities do health care providers have in this situation?




Subject Cultural Integration Pages 4 Style APA


Cross Culture Health

            This paper reviews the cause of Amiya Nidhi who recently moved from India to the US. Nidhi has been admitted to the hospital to give birth. Although she wants an epidural and her blood sister is encouraging her, she maintains that her husband will not allow such a move. The nurse who attends to her had a glimpse of the discussion and had held a discussion with her perfectly knowing that in their culture, men are tasked with household chores. Mr. Nidhi is happy that the nurse has approached her and shade more light on epidural. Based on this background information, the present paper examines the issue of epidural from a cultural perspective as it relates to the case. Precisely, the paper identifies the 4C’s of culture and discusses them in relation to the case. Further, it highlights things that would have been done differently as well as responsibilities of healthcare providers in relation to the case scenario provided.

Issue from a Cultural Perspective

              Reports have indicated that the prevalence of diversity in a country provides myriad of pitfalls and benefits for healthcare providers, healthcare models, as well as, stakeholders to formulate and adopt culturally competent care services (Hernandez & Gibb, 2020). Iwelunmor, Newsome and Airhihenbuwa (2014) maintained that a culture that entails shared norms, values and standards of a given population has important implications for human health as well as the failure or success of public health interventions. In the provided case study, Amiya Nidhi and her sister have both moved to the US. Nidhi is expectant and considers epidural birth processes, a concept that her sister supports. Nonetheless, Mr. Nidhi follows the Indian culture that does not support epidural processes.

            The culture clash is depicted in the presented case scenario. In particular, the western culture collides with the eastern culture with regards to patient autonomy. In the US, the patient is obliged to decide on the health and care administered. As such, western medicine gives priority to the principle of autonomy in administering care services not unless in extreme situations such as treating mentally incapacitated individuals (Subramani, 2017). On the contrary, the eastern culture, specifically the Indian culture bans autonomy since the head of the family is tasked with making medical decisions. As such, the case study above advances the legal and ethical dilemma since the healthcare practitioners must sensibly select a moral and legal alternative for both parties. Hernandez and Gibb (2020) posited that understanding differences amongst cultural behaviors can accord the healthcare practitioners with the skills, context, as well as, professionalism needed to offer holistic care. In the provided case scenario, the efforts put by the nurse to deliberate with Mr. Nidhi regarding the need for the epidural process for his wife can play an essential role in resolving cultural issue and providing quality care.

4C’s of Culture

             The 4C’s of culture has been adapted to direct healthcare practitioners to provide care in conflicting culture and diverse settings. The model takes the form of four ended questions to implement a cultural challenge and provide a resolution from patient’s standpoint.

How do you call your Challenge?

             Amiya is afraid of labor pain and contemplate using an epidural to lessen the pain, a concept that is supported by her sister and her nurse. However, it is impossible for her to make such decision alone that comprises the challenge in this scenario. Intuitively, Mr. Nidhi has to be consulted although he is against the idea.

What are the Causes of this Challenge?

            Amiya is concerned about the physical process of giving birth. This is what has caused the problem in the case study described above. Another cause of the problem entails avoiding labor, as well as, delivery pains. Nonetheless, Mr. Nidhi has the power to decide on whether to accept or reject the idea, forcing nurses to hold a discussion with him.

How do you Deal with the Situation?

            Nidhi comes from a culture that rejects the epidural approach of delivering process and considers other approaches to minimize labor and delivery pains. As such, Nidhi needs to be trained and made aware of the importance of using epidural intervention technique.

What Are Some of the Concerns Regarding your Condition?

             Hussain and Maheswari (2017) posited that using epidural technique can induce prolonged periods in labor wards and induce birth challenges in risky situations. Further, the epidural approach is expensive process that can cause unnecessary or unplanned costs.

Thing that Would have been done Differently

            If I was a nurse, I would attempt to understand ways in which Amiya’s behaviors are incorporated into her culture in a bid to equip myself with skills, context, as well as, empathy needed for holistic care. As such, I would plan to meet both Amiya and Mr. Nidhi and inform them the benefits of epidural approach rather than meeting each separately. Once I have educated, understood and responded to their concerns, I would give the two a chance to decision on their own.

Responsibilities of Healthcare Practitioners in this Situation

               It is the duty of healthcare practitioners to provide their patients with quality care regardless of the challenges they are experiencing. In the case scenario above, the issue of culture hinders attainment of quality care. Nonetheless, it was the responsibility of the nurse to introduce new cultural changes by discussing with the key decision maker; Mr. Nidhi to ensure that quality care is administered. Moreover, it is the role of healthcare practitioners to adhere to the principle of beneficence in delivering care to patients. Subramani (2017) posited that the principle of beneficence requires the healthcare practitioners to do everything they can to benefit their patients in any healthcare situation. This explain why Cindi ignored to meet Mr. Nidhi without involving Amaya as this would ensure that a quality care is delivered.

            In conclusion, the paper has reviewed the case of Amaya Nidhi, particularly various issues or differences from a cultural perspective. A major difference described is that in the US, the patient has the right to decide on her or his own but that is different in India where all the decisions are made by the husband who is regarded as the head of the house. As a nurse, I would have attempted to discuss epidural process with both Mr. and Mrs. Nidhi at the same time instead of meeting them differently. Clearly, this indicates that healthcare practitioners should help solve challenging issues and provide quality care to all patients.


Hernandez, M., & Gibb, J. K. (2020). Culture, behavior, and health. Evolution, medicine, and public health, 2020(1), 12-13.

Hussain, S. S., & Maheswari, P. (2017). Barriers for labour analgesia in South India – Knowledge and attitude of relevant stakeholders: A hospital-based cross-sectional study. Indian journal of anesthesia, 61(2), 170–173.

Iwelunmor, J., Newsome, V., & Airhihenbuwa, C. O. (2014). Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity & Health, 19(1), 20-46.

Subramani S. (2017). Patient autonomy within real or valid consent: Samira Kohli’s case. Indian journal of medical ethics, 2(3), 184–189.




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