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Clinical Cultural Awareness Reflection

Conor F. Horan

Department of Nursing, St. Joseph’s College of Nursing

NSG 123: Health & Illness Across the Lifespan for the Individual & Family

February 4, 2024
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Clinical Cultural Awareness Reflection

As nurses, we are going to be interacting with patients and families from all walks of life.

People of different ages, socioeconomic statuses, cultural backgrounds, ethnicities, gender

identities, social determinants of health, religious beliefs, and many other factors that may

differentiate my patients from my own upbringing and experiences. This is an enriching and

rewarding part of nursing as we are able to learn about different people and cultures through

our work. On the other hand, these different cultures and backgrounds may have different

feelings about their medical treatment and what they are or are not comfortable with. Nurses

operate in the modus operandi of evidence-based practice, and occasionally this form of

practice comes into conflict with cultural or personal preferences.

When I was completing my Pediatric rotation at Upstate Medical University, the patient

that I helped to take care of was from a Chinese background. She was accompanied in the

hospital by her mother and her older brother. While both children were raised in the United

States and spoke English, the mother only spoke a small amount of English. The patient had an

occurrence of arthritis following a strep throat infection that required a debridement surgery. As

such, the client was in a significant amount of pain and even though she was 8 years old, was

not able to communicate much beyond that she was in pain due to her condition. The mother

was very concerned, as could be expected, and was very interested and involved in the care of

her daughter. When we were in the room and aiding in the care of this patient, we talked

through what we were about to do and the medications that we were going to give with the

mother before we did anything. This was accomplished mostly by her older son translating

between us and the mother. Often the son would look up the medication that we were about to
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give, explain what it did from what he was able to find online, and explain it to his mother who

would decide if she wanted to give it or not, even though there was no time that I saw that she

actually refused something. She wanted to be informed and involved but was unable to

understand the full extent of what we tried to tell her in English. Occasionally her son was not in

the room, so we had to do our best to communicate what we were doing in a way that she

could understand with her limited English.

This was a meaningful experience to me because it was the first time that I had had an

extended interaction with someone who only spoke some English, and did not have enough

vocabulary to always grasp the medical terminology and explanations in a way that was

satisfying to her to make informed decision about her daughter’s care. This type of information

is often difficult for native English speakers to fully grasp, so it is easy to understand how much

more difficult for someone that is not quite fluent in a language. This mother was already in an

incredibly stressful environment with her daughter being ill and in a lot of pain and very much

wanting to help in any way that she could. This woman had grown up in China and had

emigrated to the United States where she had started her family. Her son told me that his dad

only sporadically had employment but that his mother worked as a waitress. Her son told me

that he was a senior at Boston University and that he was home on his winter break at the time.

While I never met the father, this mother was incredibly caring and involved in the well-being of

her children, and from what I was able to gather did not have a lot of money. However, she was

still able to support her children so that her oldest could attend a very good school and I am

assuming her goal is the same for her other children. Even though her upbringing and social and

financial situation are very different from my own experience and upbringing, seeing how she
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interacted with and cared for her children helped me to see the world as a more connected

place. This mother was just like any mother that I had seen from my own limited experience in

her desires and care for her children.

The language barrier was still a small hurdle to the care I was trying to give while I was

there. I had to make sure to give extra time to explain procedures and to be sure that I was

explaining them in simple terms and as thoroughly as I could. I also had to ensure that the

mother understood what I was telling her and that she was not just trying to be polite in trying

to let me get on with what I wanted to do instead of ensuring she understood what I was telling

her.

From this experience I learned a different avenue of therapeutic communication than I

had experienced before. I had to think about what I really wanted to communicate to this

patient’s mother and do so in a way that was clear, used simple language, but was also

thorough and not condescending to her intelligence just because she mostly spoke a different

language that I did. This is a difficult needle to thread sometimes as you do not want to come

off as treating the person as not intelligent enough to understand, but also explaining things in a

way that they are able to understand with their grasp of the English language. With this

experience in particular I learned a couple of things that could help me going forward. Cluster

care in important with all patients but especially with pediatrics. In this experience I learned

that I should be clustering my care around times when the patient’s brother was in the room

and able to translate for his mother. I had checked with the nurses before using this technique

for medical procedures and they told me that with the mother’s grasp of English and her son

there to translate that they had not found it necessary to use the official translator. Secondly,
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while I was speaking to the mother and her son was translating, I needed to still speak to the

mother and not only to her son who spoke English. I did not want the mother to feel that I was

excluding her or deferring to her son because of the language barrier. Finally, this experience

really underscored the need for me to have a very clear understanding of the medical

procedures that I am performing with a patient. With this good understanding, it will be easier

to break it down in a way that will be easier understood by patients or their family members

where there is a language barrier, or even if there is not.

I am glad that I had this experience as these types of things, like many in nursing, are

best learned by doing them then learning about them in a classroom setting. Through this

experience I was able to learn how this individual family unit operated and interacted with each

other and offer the care that best benefitted them. I was able to learn how to handle language

barriers more effectively and be able to bring what I have learned going forward in my nursing

practice.