Culture, Diversity and Care

In nursing school we learn the A to Z’s of patient care, from cardiac murmurs to difficult conversations. We practice the physical skills in lab and work with each other to become more adept at compassionate caregiving.

However, little can prepare you for what you see outside of practice scenarios. Specifically, it is the challenging human moments that can knock us down and lift us back up all in the course of a few seconds. No one tells you what you should say when you are alone with a patient who calls out in pain, begging you to “help me, help me with your heart”. There is so much beyond the physical realm that we see as nurses, and most of my peers will say this is what keeps them coming back, despite the endless hours of studying and the consistently sore post-shift feet.

Recently, we were lucky enough to welcome a speaker who acted as a guide to effective communication with our patients, a chaplain named Donna who walked us through cultural competence in our practice. The first step was to acknowledge what we were facing as practitioners. Medicine is a practice of cultivating intimacy and developing trust. Without this relationship the likelihood of a patient sharing their full history and following through on medical recommendations is slim. Donna shared with us that according to a healthcare survey published by The Commonwealth Fund assessing health care quality for minority Americans, we’ve got a lot of work to do:

52% of Asian Americans do not believe their doctor understands their background or values.
19% of Hispanics had questions they did not ask their doctor (two times more than white patients)
1% of patients needing an interpreter report having a trained interpreter
15% of African Americans felt they would’ve received better care if they were a different race or ethnicity

With numbers like these, it’s hard to know where to begin. Luckily Donna had a suggestion: start with the man in the mirror (cue music).  It is through our own process of self-awareness and self-discovery that we are able to truly be present with patients.  Our unique challenges in life and our practice of self-awareness through them may allow us to connect to our patients in their time of need. In other words, we should learn to bring our own humanity to the table. The next step is increasing our cultural awareness by becoming more well informed about the ways cultural differences may inform identity, practice of authority, and communication styles. With this combination we will be better able to create a safe space to connect authentically with our patients.

One last message from Donna? Remember to listen, and ask questions. Here is one to start, and it may be worthwhile to start practicing it on yourself: “We want to give you the best care, is there anything spiritually or culturally that we should be aware of that we can offer you?”

QPR: three letters may help save a life

Our second workshop of the year fell on the day we woke up to a new president-elect. It was a day that was tough for many of us who are currently terrified by the outpouring of news of an uptick in hate crimes and what this means for the next four years. It was a hard day for this author, and one in which I was grateful to be part of a group that is working to encourage tolerance and celebrate our differences. Needless to say, there is much to discuss on this topic, but I’ll let someone more eloquent summarize my thoughts on the matter before moving on:

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The workshop was lead by one of our on campus specialists in suicide prevention. The basis of QPR is to both destigmatize talking to those we fear are at risk of suicide and educate the community on warning signs. This program encourages everyone to become  gatekeepers by empowering individuals to follow simple steps when they recognize a crisis or warning signs of one to come:

Question
Persuade
Refer

Warning signs include direct verbal clues such as someone stating “I wish I were dead” and indirect clues such as the statement “I’m tired of life”. Behavioral clues may include donating or giving away treasured possessions, substance abuse, sudden disinterest in religion, or a sudden upswing in mood in someone who has been depressed for a long time. Situationally, one can pay attention to sudden changes in an individual’s life for clues of their mental state.

When we hear or witness these things, the key is not to ignore it and simply hope it will go away. As a society we are generally ill-prepared to deal with negative emotions, often quietly waiting for them to pass. However, these instances represent a meaningful opportunity to connect and ask compassionate questions. The next step is to persuade them to get help by being persistent and following up. Finding a place to refer is luckily now quite easy, however, ensuring an individual gets that needed help is more difficult. Accompanying the individual to an appointment, calling them to check in, or sitting with them and discussing options are all powerful ways that we can assist those in crisis.

As nurses, familiarizing ourselves with warning signs and becoming skilled in having difficult conversations needs be part of our training. Regardless of our position, preventing suicide is everyone’s business.

National Suicide Prevention Lifeline: 1-800-273-TALK
The Trevor Project: 1-866-488-7386
County of San Diego Access & Crisis Line: 1-888-724-7240

Dia de los muertos

Our first event of the school year was a celebration of dia de los muertos, or the day of the dead. One of our own from the MEPN program, Annette, generously offered to share her experience with this holiday and led a discussion regarding the traditions surrounding it. This tradition is centered around the alter, and in this case we dedicated it to Florence Nightingale, the lady with the lamp.

The ofrenda (alter) is meant to keep the family close, traditionally built at the cemetery where the loved one is buried. The deceased are honored with food, drink, and gifts of the things that they loved. It is believed that during these days (November 1st & 2nd) the loved ones can enter the world of the living and that to honor them brings good fortune.

Annette led a discussion on evolving traditions, including the newly established day of the dead parade in Mexico City, as well as the rising popularity of la Catrina, pictured in the painting by Diego Rivera on the screen above. She is an iconic figure within Mexican culture, representative of a more jovial approach towards death.

The group listened while munching on pan de muerto, a traditional bread representing the skull, bones, and circle of life.  Annette’s mother was able to pick it up in Tijuana, a reminder as we ate of the geographical and cultural proximity we share to Mexico. We washed down the pastries with hot chocolate, commonly enjoyed during this holiday and a treat on a San Diego fall day.

It was a powerful first gathering, made more meaningful by a student teaching the group a piece of her own cultural heritage to the benefit of those who came. We are looking forward to seeing what this group can accomplish this year!