Communication Barrier: "Untie Me Now!" | Nurse in Action

Woman found unconscious in a large grocery store, no ID, language issues, combative in the hospital and restrained. How can the nurse help her?

Communication Barrier: "Untie Me Now!" | Nurse in Action

Patient Presentation

"She did what?!"

"Yup! She threw the stool and urine straight at Dr. Clean!"

"You gotta be kidding! So what's her story?"

"Well! Apparently they found her 2 days ago at GreenMart unconscious by the milk refrigerator. One of the employees called 911 and they brought her here. They can't figure out what language she speaks. She has no ID or cell phone."

"Great! So what's the plan for her?"

"We don't know her history but she might be Diabetic. Her finger-stick glucose at the scene was 46. So the glucose is being monitored. Her labs were OK and her EKG and chest X-ray were negative. Since she was combative, she was restrained. She has been registered as Jane Doe!"

"Looks like this is going to be an interesting day! See you tonight?"

"I'll be here!"

"Well, get some sleep, Tess. Thanks for the report."

Tess turned as she reached the door and laughed.

"Annie, she spits across the room! Be careful!"

I sighed and shook my head.

"Just what I wanted to hear to start my day!"

Nursing Assessment

I made quick rounds on all patients and peered through the door glass into Jane Doe's room. She looked like she was sleeping. Her telemetry rhythm was sinus and the vitals on the telemetry monitor at the nurse's station was within normal range. Her next order was for a finger-stick glucose in 2 hours, so I had some time. I quickly settled my other patients, scanned  through her paper chart and then gowned up in full PPE's before I opened the door softly. These were before the days of formal language interpreters, electronic charts and iphones.

I walked closer to the bed and silently observed her sleeping. Her hair was uncombed and there were tear stains on her cheeks. Her hands and legs were tied. She wore a long gown and a scarf lay on the floor amidst straws and blood soaked gauge and band aids. One of the hands was in a fist and was clutching on to something. I took a step forward and peered at it.

It was a wooden Tasbih, an Islamic prayer bead.

The woman was a Muslim! She probably had a dialect that was Beuodian (an ethnic group of nomadic Arabs).

How Did I know All of This?

Five years before, I was working in Saudi Arabia in a remote village with Beuodians and spoke fluent Arabic. I knew their culture, customs and dressing. This woman was most probably from Saudi Arabia.

I went over and took the scarf and shook it. It looked clean. I went and touched her arm gently. Her eyes flew open and she stared at me with frightened eyes. I must have not inspired any confidence in my full PPEs!

Praying that she wouldn't spit at me, I took off my face shield and mask so that she could see my face.

"Salam Malaekum Ukht " (pronounced uktu) meaning greetings sister!

Tears pooled in her eyes as she whispered back, "Malekum Salam" (greeting to you!)

I motioned with my hand and spoke to her in Arabic.

"May I put your scarf back on your head?"

She nodded, the tears flowing freely now. I gently combed her hair with my hands and tied the scarf around her hair. For an orthodox Muslim woman leaving her hair uncovered for others to see is considered "haram"(forbidden) and a scarf or Hijab is an easily identifiable sign of her faith. Just like some people wear a cross as a Christian identity.

Gaining Trust

Putting her scarf back on showed my respect for her and her faith. This also was a tiny step to gain her trust.

I gently patted her hand and pulled up a chair and sat by her bed.

Even though I spoke Arabic well, her dialect was hard to understand. The words poured out amidst sobs. She kept saying the words over and over again.

"Untie me now! Please. Untie me now!"

I raised my hand slightly and spoke to her.

"First give me your name."

"Saida."

"What is your husband's name?"

"Ismail Mohamed".

"OK. Do you know your address?"

"No."

"Do you know his phone number?"

"Yes."

"That's very good. Give me the number."

I wrote it down and then touched her.

"I am going to untie your hands now. Promise you won't hurt me."

"I won't."

I gingerly untied her hands (left the legs tied, just in case she lunged at me).

Massaging her reddened wrists with some hospital lotion, I smiled at her and asked,

"Shall we call your husband?"

She sat up eagerly as I dialed out and was connected to her frantic husband.

I calmed him down, told him what happened and gave him the phone number to the room and the address of the hospital. Saida tearfully spoke to him.

I found out that they had come to visit their son Ali in New York and only been in the country for 2 weeks. The first week, the father had a fall, broke his ankle and was on bed rest. Ali gave his mother money and taught her to buy essentials like milk, eggs and cheese from the local Greenmart. He went out of town for the weekend on work and the father did not have his number. Ali had given his contact numbers to the mother who had kept it safely in the apartment! Anyway, he was supposed to come back that night. The father did not know the emergency systems (call 911, call hospitals, police, etc.) and barely spoke English. So he was home worried and helpless.

Now that Saida was calmer, I untied her legs, took her to the bathroom and helped her with a warm shower and a clean gown. I put her back on the phone with her husband and made her a cup of hot tea. Her finger-stick glucose and vitals were fine.

Her husband had given me a brief medical history-HTN, DM and an allergy to Penicillin. No surgeries in the past and 2 hypoglycemic episodes a few months ago in their country, Saudi Arabia. I called Dr. Clean who was very glad to hear the news, discontinued the restraint order and asked me that he be paged as soon as the son arrived.

Ismail, her husband, was going to send their son Ali to the hospital as soon as he came back. I called and alerted the security desk and let them know to let him up whatever time he came, given the circumstances. I then called the kitchen and requested a tray with rice, salad, fish and olives. I also got her a stash of teabags and sweet and low instead of sugar! I also gave her a cotton sling wrap to cover her hair as she had washed her scarf and it was hanging in the bathroom to dry! We both laughed when she put it on, as it looked so different from her ornate scarf!! I also called the Nursing office and asked for help to get an Arabic interpreter ASAP.

I went back to my other patients and checked in on her periodically. She was a bit anxious but otherwise a model patient for the rest of the shift! When Tess came back that night to get report, I showed her a wet spot on my uniform (water spill) and mournfully told her "Spit" to pull her leg!

I then told her what happened and that it was not spit! She promised to look out for the son Ali and page Dr. Clean when he arrived at the hospital. I told Saida that I would be back the next day and went home feeling good inside.

Cultural Competence and Knowledge On Other Faiths

Looking back to this incident, I realize the importance of cultural competence and knowledge on other faiths and what is important to them. EMS was following protocol when they removed the scarf and put her on a C-Spine collar and board. She grew agitated when she saw where she was, couldn't communicate and had her hair uncovered. It just went downhill from there!

As a new graduate, I had gone and worked in a remote village in Saudia as a Public Health Nurse with poor nomadic villagers while my classmates landed hospital jobs from Medical Surgical, Telemetry, ED, ICU, CCU to NICUs and Cath labs. I always wondered what good my experiences there would be in America and worried that I did not have their kind of expertise. I realize now that my experience there helped the right patient at the right time and made a difference in Saida's life at that moment. Even later on in life, the Saudian experience has served me to break the ice and gain the trust of many Muslim patients especially post 911, when many innocent Muslims were targeted. At the end of the day, I find all experiences useful to bring warmth and kindness, when our patients are at their most vulnerable.

Patient Discharge Teaching

Saida was discharged the next day home and showered me with blessings before she left.  When discharging her, I reminded her to always carry some ID, a phone and a medical card with medication names and allergies in her purse. She shook her head and said she was not stepping out of the apartment again! Matter of fact, she just wanted to go back home to Saudia with her husband! I told her that Inshallah (God willing/by the grace of God) things would get better and she would start enjoying her visit! We also reviewed DM, causes, treatment, diet and signs and symptoms and treatment of hypoglycemia and hyperglycemia before they left the hospital.

She came back with Ali, a week later, with a gift for me - a Tasbih (prayer beads). I have it next to my rosary!

References

American Diabetes Association (ADA)

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spotangel

About spotangel, DNP, RN, NP

Chronic Care Coordinator

Wife, Mother, Writer, Friend & Nurse! Love God above all!

24 Articles   519 Posts

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Specializes in Mental health, substance abuse, geriatrics, PCU.

This is a very good story and I'm glad you shared it with us. I am envious that you are so well traveled and have been able to immerse yourself in another place. I live in a not so diverse place so I definitely have to research when I come across a patient with a culture I'm not familiar with. In the past I have found that it's the simple things and gestures that helps to foster that initial trust, in your case it was her scarf, I've had it be a blanket, a drink, etc. usually if you can make that initial connection things come together even if there is a language barrier. 

I think in today's increasingly complex world we could use more education on different cultures and countries than what we get in nursing school. 

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

You are so on point with what you said.I can’t agree enough!

I still remember talking to a pt who  waited 2 days for a telemetry bed( common when the hospital is packed). She told me she was kept there waiting as she was Muslim. I had to de program her and educate her-about how beds were assigned. It still was a gut punch to think how a patient perceived a delay in admission bed as discrimination based on religion. It just made me more aware when I talked to patients.

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Specializes in Psych (25 years), Medical (15 years).

I can only repeat the compliments I have posted about your other articles, like exemplary communication, care and fluid reading, Spit.                                                 a.. er... I mean, Spot!

There is so much I could say about this, but suffice it to say that you truly are a professional caregiving angel.

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Brings me back to over 40 years ago.  Working evening shift on Christmas in a small hospital, received a new admit from ER: post-CVA.  Patient was an elderly woman, non-responsive, with stertorous breathing.  Maintenance IV.  No meds.  Clearly sent to us as end-stage.  No family.  Had no idea what language she spoke.  All I could do was monitor her VS as ordered, and watch as her life's flame slowly dimmed.  As often as I could, I sat beside the bed, touched her arm, and murmured "Mama."  Figured those would be the only things she might sense.  

I left at the end of my shift, and when I returned the next day she was no longer there.   

Thank you for your writing and your influence, spotangel.

 

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.
29 minutes ago, Davey Do said:

I can only repeat the compliments I have posted about your other articles, like exemplary communication, care and fluid reading, Spit.                                                 a.. er... I mean, Spot!

There is so much I could say about this, but suffice it to say that you truly are a professional caregiving angel.

Thanks Dovey  I mean Davey!! 
You had me spitting my black coffee! It does not taste good when it’s coming out your nose!! LOL!

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.
15 minutes ago, dianah said:

Brings me back to over 40 years ago.  Working evening shift on Christmas in a small hospital, received a new admit from ER: post-CVA.  Patient was an elderly woman, non-responsive, with stertorous breathing.  Maintenance IV.  No meds.  Clearly sent to us as end-stage.  No family.  Had no idea what language she spoke.  All I could do was monitor her VS as ordered, and watch as her life's flame slowly dimmed.  As often as I could, I sat beside the bed, touched her arm, and murmured "Mama."  Figured those would be the only things she might sense.  

I left at the end of my shift, and when I returned the next day she was no longer there.   

Thank you for your writing and your influence, spotangel.

 

Dianah that’s beautiful! What an instinctive way to bring comfort to a dying patient! The last sense to leave is hearing. I am positive that you brought her comfort as her spirit got ready to go home. Kudos Nurse!

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Specializes in Community health.

Wow this is beautiful. 
 

I gave birth overseas and while I spoke a little bit of the language, not nearly enough to navigate any medical problems or crises. None of the hospital staff spoke English either. Fortunately my birth went smoothly and with nothing unexpected happening— but I was so aware of how vulnerable we were, and that if something DID go wrong, my husband and I would be totally lost as to what was going on. (Of course I’m sure phone translators were available but in an emergency that would be low priority for the staff). Thank goodness you were able to speak to this woman and help her and the nursing staff communicate with one another. 

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Specializes in Travel, Home Health, Med-Surg.

Another beautiful article, I am glad you were there to help!

Reminds me of a situation also. I had a dying patient who only spoke Spanish and her daughter only spoke Spanish also. We had translators but they were not always available. The only way I could communicate to them was non-verbally. The pt was for the most part unresponsive. All I could do was show comfort to the daughter (and pt at times); through my eyes/facial expressions I conveyed empathy and support, I (at times) held their hands, I knew they were Catholic so I prayed (out loud) for/with them. I could tell by the non-verbal responses of the daughter she was grateful although we never exchanged words. The pt passed later that day and I again sat with the daughter until she was OK and left, she hugged me prior to leaving. The next day she came back (to pick up belongings) with another family member who spoke English and they tracked me down because she wanted to tell me how much she appreciated the caring "words and conversation". 

 

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

That was a beautiful response helping a dying patient @Daisy4RN. Your instinct to use what was important to the patient and family spoke volumes of your care and concern for that dying patient and family. That was especially felt by that daughter who was appreciative of the value and respect you gave her dying mother. What a beautiful thing to do. It’s the caring that counts in the end. Good job Nurse!

Love transcends all barriers of language, race and cultures. We nurses know how to make a patient feel loved and cared  even in the midst of the worst day of their life or nowadays in the middle of a pandemic! We may not be feted by others but our hearts know well when we do good! That feeling is priceless!

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Specializes in Critical Care.

God bless you!  Keep sharing your patient experiences with us.  They are informative and inspirational.  Thanks for reminding us why we became nurses and how little things can make such a difference for our patients.

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Thank you @brandy1017. I appreciate that!

 The little things and the little people are the ones that count. I learned that lesson from my dad who was able to carry genuine conversations with a poor fisherman who sold fish to a company and the global CEO of that same company. Both my parents looked around their lives to see who needed a helping hand and helped them generously without any fanfare even though we wore hand me down shirts and skirts from our older siblings and lived in a rented house. I am eternally grateful to have been blessed with them as my parents! Their names were Joseph & Mary!

Another influence was my fundamentals of nursing professor who asked us a question, 6 months into our first year. Could we tell her the name of the security guard at the guard house at the gates of the college? I didn't know and made it a point to find out. I realized then that knowledge without human connections was useless. I took that lesson to heart and made sure I knew the name of the cleaning crew, the front desk staff in the lobby and the parking lot attendant etc at every job. A parking lot attendant Sami, from an old job now is a billing supervisor at my health system and we work in the same building. He always credits me for pushing him to go back to school every time I rolled down my windows to swipe my card. Now we greet each other cordially when we walk into to work and encourage each other to lose weight!! LOL!

God willing, I hope to share my life experiences.

Know that every single story is true with names changed to protect identities and institutions and of course not get sued! I am grateful to @allnurses for publishing my stories and helping me make my dream of being a writer true!

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