Amazing Grace: A Journey of Health, Hope and Healing

Background:

Providing culturally sensitive care poses many challenges including communication difficulties, unfamiliar customs, family dynamics and dietary variations.  Understanding and accepting the culture of the patient you are caring for is as important as understanding their health concerns.   “Grace” provided us with a beautiful example of that lesson. “Grace” immigrated to the US from Liberia in 2004.  She suffered the loss of most of her family during the war and her only daughter accompanied her to their new home. She brought with her many challenges and strengths. 

Case:

“Grace” came to the clinic at 16 weeks gestation and extensive testing revealed the fetus had multiple life threatening anomalies. Numerous clinicians attempted to inform and advise “Grace” as to the viability of her pregnancy however “Grace” believed God would not give her a baby with a problem, and if the baby was sick she would feel sick too.  She refused to return to Maternal Fetal Medicine and declined to participate in any planning for the birth and care of the neonate.  Understanding health information is every woman’s right, and improving health literacy is every nurse’s responsibility (Kettering, Lessick, & Wood, 2007).  With the team knowing a lethal fetal anomaly was present we all grew more anxious and frustrated in finding the best way to care for “Grace” for the remainder of her pregnancy. An Ethics consult was obtained and Schwartz Rounds was utilized to assist staff with all the emotions surrounding this case.

Conclusion:

 A plan of care was formulated by the Interdisciplinary team which incorporated pastoral care services to meet “Grace’s” spiritual needs.  A collaborative model incorporates a partnership between disciplines and includes knowledge sharing and problem solving, all while placing the patient at the center (Bozeman, 2011).  Three physicians’ volunteered to be on call and attend a vaginal breech birth.  With a known lethal anomaly, it was decided that resuscitative measures would be futile and cause more harm than good, so we prepared for palliative care.  Pastoral care and a Labor and Delivery nurse trained in Bereavement volunteered to be present at the birth.  Despite the difficult situation “Grace” later expressed to us that she felt very well cared for throughout her experience.

In the end, “Grace’s” journey taught us all lessons in patience, acceptance and understanding of the human condition.

Keywords: culture, communication, interdisciplinary, understanding