In honor of International Nurses Day, Emily George contributed a guest post to the MHTF. Emily is a registered nurseat Boston Medical Center. She also holds an MPH in International Health. The MHTF invites you to read her reflections on the importance of extensive training for nurses on cultural sensitivity in order to provide patients with the highest quality care—particularly during pregnancy and delivery.
Her post is particularly relevant given the recent findings published in the Lancet that suggest increases in maternal mortality in several developed countries. In addition, Amnesty International recently found that minorities, women living in poverty, Native Americans, immigrant women and women who speak little or no English are at increased risk of maternal death in the United States.
One of the most wonderful things about being a nurse is the unique role we have with our patients. This role automatically encourages vulnerability and transparency from patients to express things that they may not express to their physician. Furthermore, it is a role that comes with immense responsibilities to be both compassionate caregiver and attentive advocate.
Part of that responsibility means acknowledging the disparities in access and quality of care that many minorities face—an often overlooked and underlying factor that can contribute to poor maternal health. Increasingly, studies are showing that patients who face cultural and language barriers have worse maternal and infant health outcomes.
Generally, research has demonstrated that patients report high levels of satisfaction with their nurses. However, a recent study by Wikberg, et al released in 2010, explored approximately 1160 female patient perspectives from over 50 countries on the provision of intercultural maternal care in the Nordic countries and found that this area of care had been extremely neglected by nurses.
These results seem especially disturbing given that pregnancy, labor and delivery are some of the most sensitive, unguarded times for any woman and should be handled with the utmost respect by clinicians.
Similar to Alice in Wonderland…
The researchers compared the women in the study to Alice from Alice in Wonderland. Like Alice, these pregnant women find themselves caught up in the wonder of a foreign land – not knowing where to go or whom to trust, experiencing communication problems, and meeting strange or unkind people – all the while desperately needing medical and emotional attention.
The common feeling these women described was powerlessness: not knowing what was happening to them, not being listened to, and not being able to influence the situation. Consequently, these women became silent, passive, and avoided or interrupted the care being provided to them.
A few nursing considerations…
Education of different cultures is not enough because there is a risk for stereotyping when differences are focused upon. Nurses need to not only learn more about the specific cultures of their patients; they must learn what their patients need, want, and expect on an individual basis.
During the initial visit, the nurse must inquire after the patient’s personal wishes and concerns surrounding her care. Secondly, professional interpreters of the same sex need to be available for the patient. When this is absent, true communication that promotes the relationship between nurse and patient cannot occur.
Educational materials in other languages must be available, as well, so the patient has a variety of resources to ensure complete understanding of what is to be expected during pregnancy, birth, labor, and the postpartum period.
Finally, a culturally diverse staff of nurses is also important so that when situations arise like a patient who has undergone the trauma of female circumcision, culturally and medically competent clinicians are available to provide optimal care.
Walking through pregnancy, labor and birth with a woman is a privilege and an honor for any person, especially one who is responsible for providing medical attention and care. As nurses, we must strive to protect this vulnerable and beautiful time for every woman by honoring her personal wishes and providing her with the highest quality care despite language or cultural barriers; thus preserving every woman’s dignity – and even our own.
Emily George, RN, MPH works in the Hematology and Oncology Clinic at Boston Medical Center, and also works as an independent researcher and capacity-building consultant. For more information on her work in health, human rights and development, please visit her blog.