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?”

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