When Cultures Collide: Staff Knowledge Deficits Meet a Laboring Woman's Fear
- Discuss the factors in this case study that led to cultural incongruence and less than optimal patient outcomes.
- Summarize the aspects of culture related to childbearing that may influence quality of care and patient outcomes.
- Identify interdisciplinary resources to improve culturally congruent obstetrical care.
The United States' population is becoming more culturally diverse yet the nurses providiing care are mostly homogenous. This dynamic demands attention to the issue of transcultural nursing.
Case:
This presentation will discuss how cultural variation, language barrier and the misinterpretation of a patient’s fear and grief in a Latino childbearing woman resulted in adverse patient health care outcomes. In the middle of the night, a Mexican woman comes to the hospital in active labor. She and her husband do not speak English. There is no translator in the hospital. The physician and nurse speak some Spanish and try to connect to her with difficulty. Labor becomes complex and the woman’s behavior gets louder with hyperkinetic shaking. She receives a diagnosis of possible psychosis. A cesarean with general anesthetic follows because of her perceived unusual restless behavior. Complications follow: over sedation, some respiratory depression and a post partum hemorrhage. On the following day, once stabilized, her baby is brought to her. The patient reaches out for her baby wailing loudly. Hugging her baby tightly she rocks her body back and forth crying in an expressive voice. Eventually, via a phone translator the staff learns that the patient's behavior was influenced by her fear. She thought that she was dying and that her baby had already died just like her sister and baby in Mexico had died in childbirth.
Conclusion:
Contributing factors to this cultural collision included knowledge deficit, misinterpretation of patient behavior, delayed use of a professional medical translator and lack of utilization of interdisciplinary resources. Implications learned are that everyone gains from transcultural nursing knowledge. Nurses should seek and embrace specific specialized knowledge about the culture of their clients from the vast body of literature in transcultural nursing practice to ensure culturally congruent nursing care. Informed nurses gain an understanding of the perspectives, traditions, values, practices and family systems of culturally diverse individuals and families in their care. Furthermore, sensitivity and diligence in developing one’s own self-awareness of personal and professional culture enhances communication across cultures. In turn, individuals, families and communities have improved health and well-being outcomes.
Keywords: transcultural nursing, cultural competence, patient care outcomes
