Rice at Nine, Fasting on Ekadashi and a Son Who Reads English: A Cultural Needs Assessment of Bhutanese Nepali Adults at a Hospital Diabetes Center
Student Name
American College of Education
NUR5063: Patient-Centered Care
Module 2 Assignment
Instructor Name
January 19, 2027
The Population and the Question
The composite hospital diabetes center introduced in Module 1 serves a city in Northeast Ohio that became home to several thousand Bhutanese Nepali refugees after resettlement to the United States began in 2008. Most are Lhotshampa, people of Nepali language and heritage from southern Bhutan who were forced out in the early 1990s and spent up to two decades in refugee camps in eastern Nepal. The center's records show 412 active patients from this community, about a third of its caseload. Their median A1C is 8.6%, compared with 7.6% among the center's other patients, and they miss 27% of scheduled visits.
Those numbers fit a wider pattern. A scoping review of long-term health outcomes among refugees resettled in the United States found that diabetes and hypertension were among the chronic diseases most often reported for Bhutanese adults, and that refugee adults faced a higher risk of diabetes than people born in the United States (Kumar et al., 2021). In Northeast Ohio specifically, a community survey of Bhutanese refugee women found that almost two thirds were overweight or obese, although self-reported diabetes was lower than clinic data would suggest, perhaps because many cases were undiagnosed (Bhatta et al., 2015). The question for this assessment is what the center needs to understand about this community's beliefs, relationships and daily life in order to deliver the patient-centered care defined in Module 1.
Framework and Sources
The assessment borrows its framework from medical anthropology. Kleinman et al. (1978) argued that patients and clinicians hold different models of what an illness is, what causes it and what should be done, and that care improves when the clinician asks about the patient's model and negotiates between the two. Their questions, such as what the patient calls the problem, what the patient thinks caused it and what treatment the patient expects, were translated into Nepali and used in two community listening sessions at the local Bhutanese community association, attended by 26 adults with diabetes or caring for someone who has it. A trained community interpreter co-led both sessions.
Three other sources were used: the center's records for language preference, interpreter use and visit attendance; interviews with four center nurses and a dietitian; and published research on Bhutanese refugees with diabetes and chronic disease in the United States. Every finding below describes a tendency reported by many people in this community, not a trait to be assumed in the next patient who walks in.
Findings
Language and literacy. Of the center's Bhutanese Nepali patients, 71% list Nepali as their preferred language, yet a trained interpreter was documented at only 44% of their visits in the past year; at the rest, a family member or no one interpreted. Many older adults cannot read Nepali or English. In a Philadelphia study of Bhutanese refugees enrolled in a navigation program, 97% had limited English proficiency and 69% had limited literacy (Yun et al., 2016). The center's printed materials are in English, with a Nepali version of one hypoglycemia sheet.
Family and decision making. Most patients in the listening sessions live in households of three generations. Adult sons and daughters-in-law often manage appointments, insurance and medicines, and several elders said they would not change a medicine without asking their son. Yun et al. (2016) found that help-seeking in this community begins within social networks and relies heavily on bilingual family members, and that people preferred a helper who acted on their behalf. In a qualitative study of Bhutanese refugees with poorly controlled diabetes in Kansas, family and community support emerged as central to managing the disease (Timsina et al., 2022).
Beliefs about diabetes and medicine. Participants most often called the illness sugar, attributed it to stress, sweets or life in America, and several described it as a disease that comes and goes. Some stopped metformin when they felt well or when their sugar readings were normal, believing the medicine had finished its work. Insulin was widely feared as a sign of the final stage of the disease. Timsina et al. (2022) reported that participants wanted to engage in their care but faced many barriers, and that improved health literacy was their own leading recommendation.
Food and faith. Rice is eaten at the main meals, and many households eat their largest meal late in the evening. Most participants are Hindu, and many older women fast on Ekadashi twice a month and during festivals such as Teej, some without food or water for a day. None had discussed fasting with a clinician, and three described low blood sugar during a fast. Participants also described a strong wish to walk and garden together, which matches reports of walking groups led by community members that elders attended faithfully (Asdigian et al., 2022).
Access. Visits are missed most often because a family member who drives or interprets cannot leave work, and letters about appointments arrive in English.
Adjusting Care to the Findings
Each finding leads to a change. For language and literacy, the center will require a trained interpreter, in person or by video, for every visit with a patient who prefers Nepali, will stop using family members as interpreters except in emergencies, and will replace printed handouts for patients who cannot read with picture-based tools and recorded teaching in Nepali, which Module 3 develops. For family decision making, the intake will ask each patient who else should be involved in decisions and will record the answer, so that the nurse can invite that person to the visit or a follow-up call with the patient's permission.
For beliefs about diabetes, the nurse will ask the explanatory model questions at the first visit and whenever control worsens, and will explain diabetes as a lasting condition in the patient's own terms, including why medicine continues when readings are normal. Insulin conversations will start early, before insulin is needed, so that it is not heard as bad news. For food and faith, the dietitian will build meal plans around rice and the late meal rather than against them, and every patient who fasts will receive a fasting plan agreed with the prescriber. For access, the center will offer visits in the late afternoon one day a week, send reminders by voice message in Nepali and work with the community association to start a walking group led by a community member.
Limits
The listening sessions drew people connected to the community association and may have missed the most isolated elders, who are often the ones with the worst control. Younger adults were underrepresented. The published studies come from other cities and may not match this community exactly. The assessment should be repeated after a year, and the patients who miss the most visits should be reached individually, with a Nepali-speaking community health worker, to hear what the sessions could not.
References
Asdigian, N. L., Kramer, B., Shrestha, M., Dhungel, R. K., Rizal, H., Kulung, D., Sharma, A., Dhaurali, G., Sharma, B., Rosa Galter, M., & Ratcliff, D. (2022). Community-led health promotion groups in a Bhutanese-Nepali refugee community. Health Promotion Practice, 23(5), 743-748. https://doi.org/10.1177/15248399211019057
Bhatta, M. P., Shakya, S., Assad, L., & Zullo, M. D. (2015). Chronic disease burden among Bhutanese refugee women aged 18-65 years resettled in Northeast Ohio, United States, 2008-2011. Journal of Immigrant and Minority Health, 17(4), 1169-1176. https://doi.org/10.1007/s10903-014-0040-9
Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251-258. https://doi.org/10.7326/0003-4819-88-2-251
Kumar, G. S., Beeler, J. A., Seagle, E. E., & Jentes, E. S. (2021). Long-term physical health outcomes of resettled refugee populations in the United States: A scoping review. Journal of Immigrant and Minority Health, 23(4), 813-823. https://doi.org/10.1007/s10903-021-01146-2
Timsina, M. K., Peltzer, J. N., Pokharel, Y., Peterson, J. M., Schwartz, L. J., & LeMaster, J. W. (2022). Understanding medication adherence in Bhutanese refugees with diabetes in a Midwestern city. Journal of Transcultural Nursing, 33(3), 324-333. https://doi.org/10.1177/10436596221077671
Yun, K., Paul, P., Subedi, P., Kuikel, L., Nguyen, G. T., & Barg, F. K. (2016). Help-seeking behavior and health care navigation by Bhutanese refugees. Journal of Community Health, 41(3), 526-534. https://doi.org/10.1007/s10900-015-0126-x
How this NUR 5063 Module 2 example is structured
NUR 5063 Module 2 often assesses the cultural needs of a named population and adjusts care to them; your classroom's instructions decide the framework and whether primary data are expected. This example names the population and its history, states the assessment framework and data sources, reports findings under language, family, beliefs, food and faith, and access, and matches each finding to a change in care, while warning against treating group tendencies as rules for individuals.
NUR5063 Module 2 questions, answered
What does NUR5063 Module 2 usually ask for?
NUR5063 Module 2 often asks you to assess the cultural needs of a named population served by your organization and to explain how care should be adjusted in response. Many sections expect a named cultural assessment framework. Your classroom's instructions decide the framework and length.
How do I avoid stereotyping in a cultural assessment?
Describe patterns as tendencies reported by the community, cite where each comes from, and say plainly that individuals differ. Then design care changes that ask each patient rather than assume, such as asking about fasting instead of assuming who fasts.
Do I need to collect my own data?
Not always. Many students combine published research with their organization's records or informal conversations with community members. If you include anything you gathered yourself, describe how and keep it de-identified.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.