2013 Winning Essay

2013 A Nurse I Am Scholarship winners were asked to answer the following:

A. The movie "A Nurse I Am" provides a wealth of insights and approaches to be considered by future nurses, new nurses and seasoned nurses. According to Joyce Newman-Giger, "When nurses consider race, ethnicity, culture, and cultural heritage, they become more sensitive to clients.” Considering this statement, what two nurses in the film seem to best portray or consider the importance of culture in their approach to patient care? Explain why.

B. The United States thrives as an expanding multicultural pluralistic society. As a nurse, how and why will you step forward to offer culturally competent care?

John Haddock

University of North Carolina - Chapel Hill School of Nursing

A Nurse I Am: Let’s Make Them Feel Good!

In the words of Dr. Carl Rogers, “When someone really hears you without passing judgment on you, without taking responsibility for you, without trying to mold you, it feels damn good.” Such an approach seems straightforward in theory, but truly listening in a focused, nonjudgmental and unbiased manner is a developed skill requiring sufficient self-discipline, understanding and compassion. As nurses, our foremost priority must be listening to patients, recognizing the importance of both verbal and non-verbal methods of communication. Mona reiterates this point stating that, “if you focus and listen to patients, they will tell you what’s wrong, but not necessarily in the words you think you ought to hear.” Not only will patients communicate what’s wrong, but they will also convey culturally appropriate interventions and goals. Nurses must be cognizant of the potential disagreement between treating the diagnosis and treating the person. Ultimately, our role is to care for patients according to their desires and standards. By disregarding personal opinions and giving our full attention to patients, nurses facilitate an environment conducive to delivering adaptive, culturally sensitive care.

The passion and resolve with which Mona Counts delivers culturally competent care to her community is remarkable. She realizes that her patient population is deep in the heart of Appalachia, rather than an affluent metropolitan area. Most of Mona’s patients lack access to proper health care, nutrition, education and financial resources. She is able to effectively prioritize her plan of care, addressing issues most important to patient-specific activities of daily living. According to Mona, “Health in Appalachia is function, not just absence of disease.” Recognizing that transportation to clinics for some patients is impossible, she makes home visits to ensure these individuals receive appropriate care. Instead of hastily instructing a man with diabetes, hypertension, peripheral vascular disease and chewing tobacco to eat better, exercise and stop using tobacco, Mona appreciates the impact that restoring ambulation has on improving progress towards broader health goals. Understanding simple patient goals in a cultural context avoids missing the forest for the trees.

Through seemingly trivial questions, Mona elicits detailed responses from her patients, thus driving her focused care. Perhaps the elderly lady’s desire to die at home was driven by cultural valuing of lifelong independence or by individual motivations. Regardless, she asked the right questions and listened to the lady who was more concerned about the manner of dying as opposed to dying itself. According to one gentleman, “Mona tells us what we need to know and can understand, not all of that college stuff. She breaks it down for us.” She understands that her patients might become offended or noncompliant were she not to speak matter-of-factly and to the point. Like Mona, nurses must listen with open ears, eyes and heart so that we may understand how to communicate best with those we serve.

In addition to prioritizing individualized interventions and goals through focused listening, nurses must not assume. Having a degree of cultural norms is certainly wise, but one must walk a fine line between assuming and using knowledge of cultural practices as a guide. When visiting her friend who is terminally ill and undergoing chemotherapy, Ardis Bush allows the patient to steer the conversation towards what she feels is important at this point in her life, rather than assuming. Through moments of therapeutic silence, it is clear that the lady places extraordinary value on family and, in particular, her son. Ardis happily agrees to listen while Richard plays the piano, thus treating the soul and spirit of her dying friend. Like Ardis, I hope that I will consistently have the courage and foresight to take off the medical hat, put on my patient shoes and walk with them down their road no matter where that road ends.

In a world of rapidly diminishing borders and indistinct cultural norms, it is imperative that nurses discover what’s important to each patient when developing a proper plan of care. Establishing a strong, trusting foundation through meaningful dialogue and interaction is vital. Answers will not always be clear, but we must be willing to learn and be humble enough to seek correct information. When patients experience effort to understand them, their personal door may open ever so slightly and we must recognize and seize that moment. If I can truly get to know patients, I can and will deliver culturally competent care. Like Ardis and Mona, if I truly hear patients, I will make them “feel good.” After all, isn’t that our ultimate goal?

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