Transcultural Nursing - Transcending Cultural Barriers to Deliver Care

And yet, somehow while caring for these individuals, I always found a way to communicate, a way to see the individual as unique, a way to value them for who they are. These people helped me identify my purpose as a nurse: to cross all boundaries, cultural or otherwise, and care for those around me.

The first person I encountered was an elderly Asian woman. This dear, sweet lady lived in a continuing care facility and battled dementia daily. She spoke and understood English very well, but sometimes reverted back to her original language of Tagalog, a language spoken in the Philippines, and would not know how to express her needs to us.

She missed her family very much and seemed lost and lonely. Although good-natured and smiley, feeding this lady was a challenge. She much preferred traditional Philippino cuisine and did not care for the North American foods served at the facility. As a result, she refused to eat and was losing weight quickly.

I became good friends with the nursing and custodial staff, many of which spoke Tagalog. These awesome people were kind enough to teach me several phrases. "Magandang umaga!" I would say to her, which means "Good morning" or "Beautiful day." I was also taught phrases that encouraged my client to eat. I came to call her "Nanay," which means grandmother. Every day, I said, "Nanay, tang ha lian," meaning "Grandma, please eat your lunch."

To my delight, this sweet little lady seemed to enjoy me talking to her in her own language! She would smile, and eat a few bites for me. It was exhilarating to find something that worked! I spent 5 weeks with this little lady, helping her eat and giving her personal care. I even talked with the facility dietician to see if they could personalize a menu for her, to encourage self-feeding and improve caloric intake.

This lady gave me my first experience with cross-cultural nursing. Even though we had very little in common, she helped me develop compassion and love for other cultural groups. To this day, I have a heart for the Philippines!

The second person I encountered was also Philippino! I was working on a medicine unit during my second practicum. He was acutely ill, short of breath, and coughing up blood. And yet, despite his fear and pain, he was wonderfully joyous! I said to him one morning, "Magandang umaga!" His eyes lit up! "Good morning to you too!" He and his family were happy to teach me more of their language and culture. I'm sure I learned a new phrase each day.

As his condition worsened each day, I started to feel very depressed. I still feel that it wasn't fair. How could it be possible that such a great man was dying a painful, scary death? This awesome, exuberant, smiley man was so loving towards his family and friends. His room was always filled with loved ones. He and his family taught me the importance of being a happy person, no matter what life throws at you.

On an additional note, I must bring attention to something I learned about in cultural studies. Certain cultural groups believe that it is important to surround the ill person with family members and friends. When you see this cultural value in action, it is truly awesome! If I am ever hospitalized, I would love to have my family support me as much as I witnessed with this man.

The third person I took care of is perhaps my greatest example of cross-cultural care. I was working in a surgical unit, and he was one of my first clients. In addition to being acutely ill, he only spoke Cantonese! I was very intimidated by the thought of caring for such a person. As a student, I had never encountered a patient with so many lines and tubes attached! IV lines, epidural catheter, drain, nasogastric tube, catheter, rectal tubing, oxygen via nasal prongs, daily dressing changes... let's just say I had my hands full!

Assessing his pain proved to be quite challenging...at first! Despite the language barrier, we started to develop a method of expression. Non-verbal communication was actually very effective! I would enter his room smiling, greeting him in English. When assessing his pain, I would first get his attention, and ask him, "Pain? Does this hurt?" while touching my stomach and grimacing. Then I would motion towards his stomach... he got the idea! After his epidural catheter was removed, he certainly would agree, "Pain!!"

His niece started to visit daily, and she acted as interpreter. She helped me talk with and understand my client in a huge way!

Working every day with this man was a great pleasure! The first day I worked with him, he looked quite sad and depressed. He made it clear that he wasn't fond of the lines & tubes placed in his body. Each day I came on shift, there would be a new order from his physician. "Discontinue catheter... discontinue nasogastric tube...etc." I got to take out something new every day! He was getting better! I was so overjoyed. This man's demeanor, expression, and mood changed rapidly! He was happier each day, realizing that his condition was improving. By the end of my rotation, he had all of his tubes and IV's discontinued and was walking around the unit daily. What a great transition to witness!

On my last day in the unit, my client and his wife told me goodbye, and his wife gave me a present. She spoke limited English but managed to tell me that they were grateful for the care I had given, and wanted me to accept their small gift as an expression of their gratitude. What an honor! Somewhere between just "doing my job" and following doctors orders, I managed to express care! It is so awesome to put Dr. Jean Watson's caring theory into action!

I am very anxious to begin my professional career as an LPN! The whole world is rapidly becoming a cultural mosaic, and I recognize the need to be culturally competent. I urge all people, not just nurses, to learn about and value other cultures! Our world is so rich, so vibrant... I am excited to continue my journey in it, learning as I go.