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1. On my pediatric rotation I once took care of a young Hispanic boy who had third degree burns on his lower legs. That day his father had been burning piles of leaves, and though the fire appeared to be out, underneath the ash was a thick layer of embers. The boy had been playing tag in the front yard and, unbeknownst to him, ran through the leaves and got embers stuck inside his Sperry’s. The mother who was currently with him spoke limited English and the other family members spoke none at all. When first walking into the patient’s room, I could tell that the family was catholic as they had figurines of mother Mary along the window seal. Obviously none of this bothered me, I just didn’t know very much Spanish or much about being Catholic. For his burns, he was going to OR today for a skin graft and had allowed me to tag along as an observer. We had to wait a considerable amount of time to get consent from the mother, as there were no interpreters on the unit and we had to wait for one to become available. Once we finally got consent, we went down to preop and were abruptly stopped by an older nurse saying “Finally! Took you about long enough to get down here!” Since it was just me, the transporter, and the mother, I was confused about who she was making the statement to. In somewhat broken English, the mother quickly apologized for not speaking better English and for making everyone wait on an interpreter. The nurse just stated, “I see,” and went back to assessing the boy. After the nurse left again, I felt kind of bad for what she had said to the mother, but didn’t know how to bring it up. We did talk for a little while about where we lived and such, but for the first time in my clinical experience, I felt greatly disconnected with the patient because we did not have much in common. I just didn’t know what to say or what to talk about. We sat in silence for a while, until the nurse finally popped back in and stated that the OR was ready for him. The mother quickly stood up and protested, stating that the priest was not here yet to pray over her son before surgery. Because we didn’t talk much, I had no idea she wanted a priest to come and felt bad for not knowing. The nurse kind of gave me dirty look, because if she had known she could have at least called the chaplain to come down. The mother really wanted to wait 30 minutes for her church’s priest to get to the hospital, but after the nurse protested saying that we would mess up the ORs schedule, she agreed to let the hospital chaplain come pray over her son. We still had to wait about 15 minutes for the chaplain to get there, but after he prayed over the boy, the mother appeared to be a lot calmer about the situation.
2. If I could see this patient and his family again, I would definitely change how I cared for them. Just because I did not know very much Spanish or anything about Catholicism shouldn’t have stopped me from effectively communicating with the mother about such topics. If I had been less scared to talk about Spanish, I would have identified early that morning that she was not confident in her understanding of English and we could have called the translator sooner. If I had been less scared to talk about religion, I would have known that she wanted a priest to pray over her son directly before surgery.
3. For this class, I have learned that it’s good to ask questions about someone’s culture if you do not know much about it. This is vital in obtaining critical information needed for culturally competent care. Biles (2020) explains that healthcare academia is largely made up of white women who lack skills in building a safe environment to discuss culture and racial inequalities. A great way for students to combat this issue is using the ARTS acronym with their instructor (affirmation, reflection, teachable moment and summary). By the instructor affirming that it is okay to talk about sensitive subjects, the student will feel encouraged and safe to reflect upon an incident (Biles, 2020). The instructor can then turn this into a teachable moment, and summarize to reaffirm the learning experience (Biles, 2020). A study by Abrams et. al (2021) found that student nurses who participated in activities involving direct patient care to minorities or disadvantaged communities had significantly higher cultural competence. By having clinical experiences such as these, and by having opportunities to reflect upon the experience (such a this), the literature supports that we are on the right track in becoming more culturally competent in our care.

Abrams, M. P., Chalise, S., Peralta, H., & Simms-Cendan, J. (2021). Social, Demographic, Spanish Language, and Experiential Factors Influencing Nursing Students’ Cultural Competence. Journal of Nursing Education, 60(1), 29–33. https://doi-org.libproxy.lib.unc.edu/10.3928/01484834-20201217-07
Biles, J. (2020). Cultural competence in healthcare: Our learning from 2017-2020 will shape our future. Australian Nursing & Midwifery Journal, 26(11), 20–25.

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1. During my Adult Health Clinical on 7BT Rehabilitation unit I worked with a patient who only spoke Arabic, originally from a country I had never heard of before, Bahrain. Unfortunately this was not a language spoken by any of the other staff on the floor and although there is access to an interpreter, it is limited. I remember walking into the patients room for the first time to introduce ourselves and get our first assessments of the day, she was sitting on the bed watching videos of animals on her tablet. The nurse I was shadowing and I introduced ourselves, smiled with our eyes behind the masks, waving, and then wrote our names down on the whiteboard. The next part wasn't quite as simple to communicate; however, my nurse and I were able to come up with a few ways to promote communication through cuing and walking through each step of the assessment as best we could. I remember wondering how she felt as we were going through the muscle strength test and gathering other information . For me personally, it wasn't that I was uncomfortable providing her care, I was more so concerned that she might not be getting the best care possible due to the language barrier. I noticed that with this patient, we did not go over really any education, nor did we go in her room unless it was time for meds or an assessment, which for whatever the reason seemed to always come after the other two patients we were caring for.  Luckily, in the afternoon her daughter-in-law came in to visit and we were able to work with her to communicate with the patient and identify some of her preferences. We were also able to find better ways to take care of the patient  through her daughter-in-law and made sure to include her preferences and the strategies within the patient's chart. This was one on my first clinical experienced and I felt very blessed to have been exposed to such a culturally diverse patient.
2. If I saw this patient again, I would try to make more of an effort to communicate with her. For instance, I could try to use a translator app, and use more nonverbals. During the early morning when she was alone, I would want to make more of an effort to go into her room and offer myself to sit with her as time allowed. I would also want to advocate more for my patient, ensuring that the interpreter comes as often as needed and that my patient got all of the necessary information to make the best recovery.
3. Based on this course, I would tell other nurses that cultural competence is not something that is learned overnight, it must be continuously worked at; but is an essential part of today's healthcare and what it means to be able to provide the best care to our ever diversifying patients. As a nurse, we are exposed to people of all cultures and ways of life, we are responsible for being open-minded, asking questions and learning to appreciate cultural differences.  "Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes," (Maier-Lorentz, 2008).
In learning culturally competency, it is imperative to recognize that culture is "multidimensional and dynamic," (Epner and Baile, 2012). Within every culture, individuals vary; and each individual may
identify with more than one cultural group. Early literature on cultural
competence heavily focused on a 'categorical' approach; in which HCP learned relevant attitudes, values, beliefs, and behaviors of certain cultural groups. However, essentially learning the 'do's and don't' for each cultural group "resulted in stereotypical thinking rather than clinical competence,"
(Epner and Baile, 2012). The best nursing care is patient-centered care, in
which the patients needs and preferences are at the center. As nurses, we should use the cultural knowledge we have gained as a template, but always ask our patients for their individualized preferences, believes, and values.

References:
Maier-Lorentz, M. (2008). TRANSCULTURAL NURSING: ITS
IMPORTANCE IN NURSING PRACTICE. Journal of Cultural Diversity,
15(1), 37-43. Retrieved from
http://libproxy.lib.unc.edu/login?url=https://www-proquest-com.libproxy.lib.unc.edu/scholarly-journals/transcultural-nursing-importance-practice/docview/219364449/se-2?accountid=14244
Epner DE, Baile WF. Patient-centered care: the key to
cultural competence. Ann Oncol. 2012 Apr;23 Suppl 3:33-42. doi:
10.1093/annonc/mds086. PMID: 22628414.

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1. This past week while volunteering at the lab at SHAC, I had an experience with providing care to a spanish speaking patient. SHAC is a clinic run by health professionals students that provides free medical care and lab work for underserved and uninsured members of the community. The woman and her husband had come as walk-ins to the clinic and had requested a pregnancy test. Typically when a patient enters the clinic they are offered and provided a translator if necessary or a bilingual care team member however, in this case a translator was not assigned to the patient and her husband. I first met the patient when I came to her room to provide her with the materials and education for collecting a urine sample in order to collect the pregnancy test. Upon entering the room I was not aware that the patient and her husband were spanish-speaking only so I spoke to the patient in English and asked her if she was ready to come with me to collect the urine sample for her pregnancy test. I immediately realized that a translator was needed when her husband tried to respond and I asked one of the bilingual medical students to come help with translating. Even with the assistance of the medical student I was still a bit confused about what the patient and her husband were trying to explain to me. Later, when we got the results of the test I went with the RN at the clinic and another bilingual medical student to the patient’s room to give her the results. This time the medical student was a lot more specific in his translation and was able to inform the nurse and I that the patient already knew that she was pregnant and that she had come in because she was concerned that she had not felt the baby move yet and she had been experiencing intense headaches. Once she reported this to us we decided to take her blood pressure and to ask the medical team to come in and talk to her about a referral for prenatal care. I felt so bad that I had not taken the time at first to ask more questions when I was initially in the room with the patient and the translator. I had felt uncomfortable and a little bit panicked because I did not completely understand so therefore I just pushed ahead with getting the test done instead of communicating more with the patient about her concerns.

2. If I was in the situation again I would have advocated for the patient and asked for her to have a translator when first entering the clinic and for her to be seen by the medical team before just ordering the test. I think due to the language barrier the medical team did not understand why the patient had come in and assumed that she just wanted or needed a pregnancy test instead of her having some questions concerning symptoms she was experiencing. I also would not let my sense of feeling uncomfortable interfere with taking the time and being patient with the translation process in order to get as much of an understanding about the patient’s history, symptoms, and questions as possible. Also although I am not very comfortable with speaking Spanish and far from fluent, I have taken several classes and would be able to communicate a bit with spanish-speaking patients. I think it would have made the patient feel like I was more interested and engaged in talking to her and learning about her concerns if I had spoken to her in her own language even if it was just simple words and phrases.

3. Based on what I have learned this semester in N320 about providing culturally competent nursing care, I would tell all nurses that I know that it can be uncomfortable and difficult to care for a patient when you do not feel that that you know about or understand the patient’s language or culture but that this should not deter you from taking the time to ask a patient about their culture and their preferences for their care. Even if you are not familiar or do understand a person’s culture you can still be respectful and appreciative of their beliefs and their requests for their care. According to the book “Delivering Culturally Competent Nursing Care” by Gloria Kersey-Matusiak, “nurses who provide care that is culturally congruent with patients’ healthcare values and beliefs are better able to promote health among culturally diverse populations, prevent complications from delayed treatment, and ensure quality care for all patients” (Kersey-Matusiak, 2019). I want all nurses to know how important it is to provide culturally competent care as well as the impact it can have and that they shouldn’t be afraid to communicate with their patients and ask them about their cultural beliefs and preferences surrounding their care. I also think it is important for all nurses to be aware about how they can assess their level of cultural competency and improve it. According to an article in the Chicago School of Professional Psychiatry journal magazine, the main steps and elements that are involved in cultural competency are cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire (The Chicago School, 2020). As nurses we first need to be aware of biases and attitudes towards people and other cultures in order to overcome them. We also need to be willing to increase our knowledge of our patient’s cultures and beliefs through speaking with them and educating ourselves. I think it is also important to be willing to seek out opportunities to care for patients with cultures different from our own in order to practice and improve our skills in developing culturally competent nursing care.

References
Kersey-Matusiak, G. (2019). Delivering Culturally Competent Nursing Care: Working with Diverse and Vulnerable Populations. Springer Publishing Company.

The Chicago School of Professional Psychiatry . (2020, September 13). The Importance of Cultural Competence in Nursing . INSIGHT. https://www.thechicagoschool.edu/insight/health-care/the-importance-of-cultural-competence-in-nursing/.

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Padlet# 2. Culturally Competent Nursing Ccare

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Padlet# 2. Culturally Competent Nursing Ccare

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1. I could think of any situation where I have to take care of a patient from a different cultural background because I am culturally different, then most of the people here in the US. I feel privilege myself that I am learning new culture every day in my clinical setting. Most importantly, one that comes to my mind and that triggered me a lot and made me reflect on myself was when I encountered a Persian woman who had mild dementia in one of the adult daycare centers in Raleigh. I used to work as a personal care assistant in one of the adult day care centers in Raleigh. I used to run a Saturday day program for senior citizens. One day I have to take care of a woman who speaks only the Persian language, and she had mild dementia. She had never been to an adult daycare center before that day was like a jail for her. Unfortunately, I was by myself at the end of the day as I used to do the closing, and that Persian lady was by herself. Every senior was gone for the day by 7 pm. The Persian woman was unsteady, and her dementia was deteriorating. She used to use a cane to balance her walking. When she realized she was by herself, she asked me something in the Persian language, but I didn’t understand what she was saying. She started becoming restless, constantly trying to get out of the door. I could not calm her down because of language differences. I called her son and her son said he will be late to pick her up that day. I was nervous, I couldn’t think of any ways to handle the situation. It was getting darker, the situation was getting worst as she was saying something in the Persian language, I used google translate and tried to translate English to Persian by assuming what she was saying like “ Your son is coming soon to pick you up, but he will be little late”. Suddenly, she raised her cane and tried to hit me. She chased me with the cane and I ran like a horse. I realized that day if I had known the Persian language or if there had been somebody to translate, situations would not be violent. It was not a good experience and a comfortable situation. Finally, her son arrived after an hour of struggle, and I realized she was asking me where she was and why she was there that day. Since her questions didn’t match with my answer that I translate in her language that triggers her violent behavior.

2. If I could see this patient again, first I would not be by myself and take care of a patient who doesn’t understand English at all or with someone whose two ways of communication are completely incompetent. After all, it will be a safety issue. Also, I would be mindful of making an assumption and google translate of what she was saying without actually knowing what she was asking. Misinterpretation of her concern was the real issue here. She couldn’t get the answer to her intended questions, so she was wild.

3. Based on what I have learned in N320 class about culturally competent care, I would suggest to other nurses that respecting and valuing other’s cultures is the heart of cultural competence. This can be acquired through increasing cultural awareness of one’s cultural perception by attending different cultural competence training (Anu-Marja et al., 2019). Understanding other’s cultures and honoring their preferences based on their cultural belief is critical while providing care to culturally diverse populations in the hospital setting. Article published in 2020 on Chicago school of professional psychology says “Cultural competence is the bedrock of the great nurse-patient relationship. Every nurse should make it a priority in their care”. Increasing one’s cultural features can be useful for easing cross-cultural encounters in a health care setting and improving the cultural competence of nurses (Anu-Marja et al., 2019). Understanding the relationship between nurses and patients is critical.

References

Kaihlanen, AM., Hietapakka, L. & Heponiemi, T.  (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(38). https://doi.org/10.1186/s12912-019-0363-x

TheChicagoSchool of professional psychology. (2020). The importance of cultural competence in nursing. https://www.thechicagoschool.edu/insight/health-care/the-importance-of-cultural-competence-in-nursing/

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(1)   One situation that comes to mind happened recently on one of my past maternal health clinical shifts. I was shadowing one nurse for the day and we had 3 couplets. 2 of the mothers spoke English while the other mother spoke Spanish. I know some Spanish, but I am nowhere close to fluent and my nurse was not fluent in Spanish either. While an interpreter was accessible for important conversations, it was not practical to use an interpreter for all encounters. Overall, I think that it was a good experience. The mom was very nice but I still did feel moderately uncomfortable providing care because when I tried to use Spanish I was afraid that I might make a mistake or offend them. My nurse and I did not spend nearly as much time with the Spanish speaking mom as we did with the other two moms, and I think the reason for that was because we both felt uncomfortable speaking Spanish. I can’t help but wonder if my nurse and I had spoken Spanish more fluently if that patient would have used to call bell more or asked us more questions.

(2)   If I saw this patient again, I would do my best to speak in Spanish more and encourage the patient to ask questions. When doing special patient education, I would also ask the patient to teach back to me what they learned so I can ensure that she understood me. Furthermore, I would be particularly vigilant about rounding checks on this patient and to spent more time in the room to ensure that I allow enough time for questions to be answered.

(3)   I’ve learned from this course that culturally competent nursing care is a continual growth process and not a skill that can be evaluated on a one-time exam. As a result of this, I would recommend that nurses approach each patient as openly as possible without carrying any preconceived notions or past experiences with them. For example, two Catholic patients could have two very different ways of living out Catholicism. I would also advise other nurses to not only evaluate their cultural competency when responding to patients but also the patient outcomes and how the patient receives the response. Shen (2015) points out in a literature review that a majority of the cultural competency models focus on the nurse’s competence and do not follow up with patient outcomes. Both parts, the nurse and the patient, are critical to the cultural competency theory. Not only are the patient and the nurse important, but I would also point out to nurses the importance of continuing education. Nursing schools are now mandating the inclusion of cultural competency objectives in curriculums. A study in 2008 did show a difference in cultural competency scores in students from their first semester to their last semester (Krainovich-Miller et al. 2008).

References

Krainovich-Miller, B., Yost, J., Norman, R., Auerhahn, C., Dobal, M., Rosedale, M., Melissa Lowry,

& Christine Moffa. (2008). Measuring Cultural Awareness of Nursing Students. Journal of

Transcultural Nursing, 19(3), 250–258.

Shen, Z. (2015). Cultural Competence Models and Cultural Competence Assessment

Instruments in Nursing: A Literature Review. Journal of Transcultural Nursing, 26(3),

308–321.

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·  Please create a note in Padlet about how your experience providing Culturally Competent Nursing Care. Remember you need at least one reply to other student's original post. Address the following points in one note:

1. Describe a situation in which you had to deliver nursing care to a person with a different cultural background? How was this experience? How comfortable did you feel providing care to this patient?

2. If you could see this patient again, would you do something different?

3. Based on what you learned in this course, what can you suggest in the delivery of culturally competent nursing care to other nurses?

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1.     During my peds clinical at UNC, I was assigned a patient who was of a different cultural background. The child and family were of Latino decent and only spoke Spanish which posed challenges throughout the shift. Since I received report on this patient and was told that a translator was being used, I was able to complete the first component of cultural awareness by paying close attention to my awareness (Deering, 2021). I became aware of my internal biases and was conscious of my feelings surrounding this situation. I was nervous of the thought of interacting with the patient because I did not speak her language. That awareness then led to me realizing my attitudes and past experiences that may affect the present situation (Deering, 2021). I found that I had a previous personal experience with someone who did not speak my language which led to a very uncomfortable interaction. I was unable to personally get to know the other person solely because of our language differences. I was unable to introduce myself in a way they understood so the conversation ended before it even began. With my awareness and attitudes examined, I was then ready to see the patient. Since no translator was able to be present, I had to say “hola” and I wrote my name on the white board. When beginning care, I was afraid she would not understand and would become resistant or afraid. To combat this, I used nonverbal hand cues. I tried explaining that I was going to give her medicine by holding the pills in my hand with water and then rubbing my stomach to show it was for her stomach. When it was time for her to change, I held up new clothes, soap, and a washcloth so that she would know it was time to wash off. She was very receptive to the hand signals. After I saw that she was understanding, I felt more comfortable. So, despite verbal communication, I was able to communicate with her nonverbally. Of course, this would not be sufficient if I was performing a procedure or explaining a medical issue but was effective and safe for daily cares. When the doctors rounded on her, an interpreter came so that the mother and daughter would fully understand. I was thankful that the doctors obtained a translator because the patient and family deserved that measure and had a right to understand the treatment being discussed. Seeing this interaction with a translator was amazing because it was as if there was no barrier.

2.     If I had this patient again, I would gain more knowledge surrounding her culture and language (Deering, 2021). I would try to learn or remember some common phrases in her language to show that I was interested and making an attempt to communicate (Alvernia University, 2016). I would also be prepared to see the patient by already having a translator ready for our initial interaction so that I could introduce myself. I think it would mean a lot and start the nurse-patient relationship off with trust and respect if that had occurred. The last competent of culturally competent care is a nurse’s skills (Deering, 2021). This involves repeating culturally competent behaviors so that they become second nature. Having more diverse patients and realizing my awareness, attitudes, and knowledge each time will help to improve my skills. Nurses owe it to their patients to be culturally competent because it has been proven that there are several benefits when practicing this. Culturally competent care improves data collection, preventive care, reduced costs, and reduced errors and missed appointments (Deering, 2021). Our patient’s safety, care, and health are our top priority.

3.     Based on what I have learned in this class about culturally competent care, I would suggest to other nurses to learn as much as you can about the patient’s culture (Alvernia University, 2016). This is showing cultural awareness and knowledge. Another strategy to provide care to patients with different backgrounds is to never make assumptions and to always ask if you do not know (Alvernia University, 2016). It is better to ask and figure out the patient wishes rather than assume and do it wrongly. Another important issue that occurs often is labeling patients. Alvernia University suggests avoiding the use of labels (2016). First ask the patient how they identify themself culturally. I would also encourage nurses to seek a diverse work setting. Staff diversity is a direct representation of the patient population and how well the unit is doing in providing culturally competent care (Deering, 2021). Another way to practice and learn culturally competent nursing care is to travel (Deering, 2021). First-hand experience with differing populations is the quickest way to learn. Regardless of your experience as a nurse, all nurses have room to improve and to learn more about different populations and cultures.

Alvernia University. (2016, July 22). A guide to culturally competent nursing care. https://online.alvernia.edu/articles/culturally-competent-nursing-care/

Deering, M. (2021, February 23). Cultural competence in nursing. https://nursejournal.org/resources/cultural-competence-in-nursing/.