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The social organization of health care experiences of non-English speaking Chinese immigrants : negotiating cultural and language differences in a changing health care context Tang, Sannie Yuet-San

Abstract

This study investigated the ways by which the health care experiences of non- English speaking (NES) Chinese immigrants are socially organized. Using discursive ethnography as a method of inquiry, interviews were conducted with 14 nurses and 10 patients of Chinese descent; participant observations were carried out to understand nurses' daily work; selected hospital policies were also reviewed. The findings indicate that nurses were aware of and respectful of the differences in care needs among an increasingly diverse population. However, notions of culture, ethnicity, "race" and language were found to operate in hidden ways to shape nurse-patient interaction. Yet, the experiences of some NES immigrant patients in receiving "lesser care" could not be reduced to personal prejudice or the lack of sensitivity on the part of the nurse. Rather, there is an important material context that organizes how nurses might read and respond to "differences" in care needs among their patients. The material context of health care speaks to the changing relations of resource allocation under restructuring. In the current health care context where there is a prime concern with budget containment, patient discharge has become an important administrative means for maximizing productivity and efficiency of the system. On the one hand, the biomedical and legalistic discourses work in tandem to facilitate patient discharge by prioritizing accomplishment of clinical tasks, such that the cultural and language needs of patients tend to be rendered as low priority. On the other hand, clinical protocols and pathways hasten patient turnover and shorten hospital stay by standardizing patient care; standardization could in turn bring about an increase in workload among nurses. Expecting nurses to respond to differences in care needs without adequate resources could result in feelings of frustration among nurses, and compromise their ability to provide adequate care across cultural or language barriers. Although financial prudence is a legitimate goal of health care restructuring, findings of this study alert us to the potential conflict between achieving the economic interest of budget containment and providing equitable care to those patients who do not "fit into" the system because of their cultural and/or language background.

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