"Gotta Love Transcultural Nursing"

by RNACHIEVER

My transcultural nursing experience began eight years ago when I was deployed in, what I thought would be the least expected place I would ever be, the Kingdom of Saudi Arabia. Being a nurse from the Philippines, I was one of those who dreamed of coming to America for a greener pasteur, but because of unavailability of visa at that time, I ended up in Saudi Arabia. 


Not knowing how to speak Arabic & dealing with a totally different from my liberated but reserve culture was tough but was a challenge for me. After two years & three months of having lived & worked there, I embraced their culture beyond a point where I didn’t want to leave the country. I’ve learned to love the place & the people, to understand & respect their culture & to finally learn that they’re not really at all bad as I’ve always known them to be. They are indeed one of the God fearing people I’ve ever known. The most significant thing I’ve learned from them is their being vocal about praising & thanking God, thus the Arabic term “Alhamdulillah”, & believing in God’s will, “Insha’Alla”.

One of the most unforgettable experience that I had when I was in Saudi was that one night when I had this 81 year old male patient one day post op CABG who, I thought, had an episode of post-op Psychosis. I say this because one day pre-op, the patient was totally with it, very calm & cooperative, but then the day after the surgery, the patient was totally different. What I remember at that time was that, he was sitting in his bed awake, staring at me, and was very quiet. In Arabic, I asked him if he was having pain. He was not responding at all & he was just staring at me. He looked comfortable though & demonstrated no signs of pain so I thought he was ok & left to get his due antibiotics. As soon as I got back to him & was about to give the IV push antibiotic, he suddenly jumped out of his bed still with all those chest tubes, catheters & cables connected to him & became very agitated, shouting & shouting in Arabic words that I can hardly understand. My colleagues came to the rescue as the patient was becoming more agitated & combative. Nobody among us had any idea what he was talking about. One of my colleagues who was even well versed in Arabic could not even understand the words the patient was shouting saying that his Arabic was a dialect that must have been spoken by the natives. Knowing that we were in a really bad situation, we had to call the ICU resident, the supervisor, & the security at 2am. The resident came & in authority, spoke to patient & the patient suddenly calmed down but continued to talk harshly in Arabic & was pointing at me seemingly accusing me of something bad that I’ve done. I was shocked & speechless thinking what the hell was going on with the patient? Where did I go wrong? The resident approached me &, maybe seeing that I was very pale, calmly said, “It’s ok, the patient thought you were giving him urine instead of antibiotic.” I said, “What?!” Everybody who was there just bursts into laughter! I was relieved & realized where I went wrong. It was my failure to tell the patient that I was to give him his antibiotic & that was because I didn’t really know how to say it in Arabic. Although I tried to tell him that it was an antibiotic in Arabic, he may not have understood me because of the way I said it. Lesson learned: Must learn Arabic when you go to Saudi Arabia. 
Still having no Immigrant visa for U.S. after my two year contract in Saudi Arabia, I applied for a job in a hospital in Dubai & got deployed in 2005 for a another two year contract but just actually completed a year because I finally got my US Immigrant visa in 2006. 

Coming to Dubai was another totally different experience for me. Actually thought, I came to India because most people I saw there were actually Indians. I barely saw the natives on the streets. Most of the people I worked with were from U.S. & Europe, some from the neighboring Arab countries. The hospital where I worked was servicing mostly the Royal families & international patients which was more of a challenge for me because I had to deal with a diverse culture & different languages. It was a good though that the hospital had translators that can be paged anytime we needed them. 

My unforgettable experience there was something that really got me in trouble that I got suspended for one day. I had this Korean patient whom I thought was a business man who, according to the history as I read on his admission notes, had a cardiac arrest when he got to Dubai International Airport as soon as the plane landed. CPR was initiated & thank God, he was revived & rushed to the hospital. Again, I was on night shift at that time & I was assigned to the patient. Since our unit wasn’t really busy at that time, he was the only patient I had. The patient was perfectly stable when I got him. Everytime I came to him, he was brimming with smile & say 'thank you' everytime I did something for him. He never really spoke too much because he was not really fluent in English. All he said was thank you. Because of that, I really thought he was very nice.
As I was sitting there in front of him staring at the monitor, he must have thought I was getting bored so he reached out for his I-pod which was sitting at his bedside table & tried to hand it over to me with his right hand. His left hand pointing at his left ear as if trying to communicate he wanted me to have his I-pod & listen to whatever music he had on his I-Pod. I told him, "No, we are not allowed to listen to music here at work". He didn’t seem to understand me & he insisted on handing me over the I-Pod. He even came up with his second English phase, “It’s good, it’s good”. Thinking that I don’t want to disappoint him, I got the I-pod & pretended to put the earpiece on my ears. Although, it wasn’t turned on, I pretended I was listening, smiling & enjoying the music. He was smiling all the time & said, “good, good...” For about 15 min, he finally got to sleep & I felt I was falling asleep too. Because I was really getting bored & because of my curiosity for the songs he had on his I-pod, I turned on the I-pod & listened to it. To my surprised, the music, although it was Korean, was so much pleasing to my ear that I decided to leave it on. My colleagues looked at me & never really said a word. The night was uneventful. I left work in the morning while my Korean patient was sound asleep & left his I-Pod on his bedside table. In the middle of my sleep during that day, I got a call from the nursing office telling me that they got a complaint from a patient that I used his I-POD at work that night without asking him permission. Although, I tried to explain myself, I was at a lost in the end. The ultimatum: Suspension for one day! Lesson learned: Don’t be so naive thinking that a person is so nice when he could actually get you in BIIIGGG TROUBLE!

So I finally came to America in 2006. This is where I got to experience a lot more about transcultural nursing especially because I came to, what I guess, the most diverse cultural city in America: New York City! I got the share of experience with different cultures totally different from my culture but I’d say, it wasn’t really difficult to blend with them since I’ve already learned the easy way to deal with it.

My most unforgettable experience in America so far is when I had this 75 y/o male Armenian patient recovering from a traumatic brain injury secondary to a fall. According to the family, the patient had a sharp mind, intelligent, & very fluent in English prior to the incident & they were totally devastated to find out that their used to be intelligent father became very incoherent, totally confused & never spoke English after sustaining the brain injury. The patient reverted back to his native Armenian language & never really spoke & didn’t seem to understand English at all! It was one of my most difficult but also the most significant encounter that I had because it changed the way I deal with patients in terms of their mental status. 

The first night I received the patient, I was given the heads up about the patient’s mental status & behavior. I was told that neuro wise, the patient is in & out of confusion & is mostly confused during the night. The patient definitely needs a 1:1 observation but unfortunately because of no available staff to sit with the patient, I ended up being with the patient most of the time. For most of the time I was with the patient, the patient was persistently talking by himself words that I absolutely cannot understand. I asked the patient a few times, ‘Are you ok?’, and he would respond with litany of words absolutely foreign to me. That was for me a confirmation the patient was really confused. A few times, the patient tries to get out of bed but then I easily manage to get him back since he seemed to follow some commands. A lot of times, he would ask for sips of water by pointing at a cup at his bedside table. For most of the night, the patient, although almost never slept, was very calm. At 5:30 am in the morning, the lab technician came to draw blood from the patient. The technician was about to draw blood from the right hand of the patient when the patient suddenly started screaming, yelling & trying to pull his arm from the technician. Again, I was surprised to see the patient acting that way from being very calm the entire night so I thought it was just part of his confused mental state and I ignored whatever he was saying because I couldn’t understand him anyway. I tried to help the lab technician by holding the patient’s arm but the patient was strong enough to pull his arm away from us. He was continuously screaming & yelling at us & became more combative that I have to call a male nurse for help. As we were trying to calm the patient and as I was trying to hold his arm once again, I suddenly felt something weird on his right upper arm. Realizing what it was, I immediately tried to roll the patient’s sleeve & to my surprise, I saw what I thought was a closed AV fistula. I was totally taken aback! I ran to the nurses' station & review the patient's chart & there it was, I saw that the patient just had an AV fistula inserted a week ago. I felt so stupid at that time not knowing & mad that such a significant info was never endorsed to me. I then realized that the patient was not at all confused! He knew he had an AV fistula on his right arm so he resisted being stuck on that arm. It was one of the most important lessons I’ve learned: Don’t underestimate your patient’s mental state even though you’ve thought all along that the patient is incoherent or confused. In addition, it is always best to get a translator before doing any procedure for a foreign speaking patient.

My transcultural nursing experiences were, I would say, challenging, exciting, interesting & really fun. Transcultural nursing is one of the things that really made me so proud to be a nurse because everyday I deal with different people. I learn from each encounter that I had with them. Until now, I love the everyday experience. After all, I believe, that to be a really successful nurse, “you gotta love transcultural nursing”.

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