2013 Winning Essay

2013 A Nurse I Am Scholarship winners were asked to answer the following:

A. The movie "A Nurse I Am" provides a wealth of insights and approaches to be considered by future nurses, new nurses and seasoned nurses. According to Joyce Newman-Giger, "When nurses consider race, ethnicity, culture, and cultural heritage, they become more sensitive to clients.” Considering this statement, what two nurses in the film seem to best portray or consider the importance of culture in their approach to patient care? Explain why.

B. The United States thrives as an expanding multicultural pluralistic society. As a nurse, how and why will you step forward to offer culturally competent care?

Ashley Smith

University of Massachusetts, Amherst, School of Nursing

Madeleine Leninger, the theoretical pioneer of culturally competent care, understood that sickness and healing occur within the context of culture and that culturally competent nursing care can significantly influence patient health outcomes. The goal of Leininger’s research was to provide a framework for nurses to examine comparative cultural care in a multidimensional manner while uncovering both particular cultural diversities as well as care universalities. In the film “ A Nurse I Am,” the two nurses from very diverse backgrounds, Ardis Bush and Mona Counts, engage with patients from equally divergent cultures; they stand out as remarkable representations of culturally competent nurses.

Ardis Bush displays a singular commitment to empathetic care that reflects an understanding of the interplay between a patient’s culture and their experience in a healthcare setting. When a client expresses concern that nurses are not managing her pain in a timely fashion, Ardis does not dismiss the patient; instead, she reaffirms the patient’s right to have her pain addressed. Since pain is a profoundly individualized sensation, this example is especially apt. Experiences of pain are as much informed by cultural beliefs as they are by neurochemical signals. In the film, Ardis states that nurses must “treat the whole person, the person who has feelings, who is going to cry sometimes.” By addressing this patient’s concern, Ardis demonstrates an understanding of just such holistic nursing care. While upholding a commitment to timely medication delivery, she empowers the patient to participate in her own care by acknowledging her concerns and providing professional validation. We often think that culture is explicitly tied to race or ethnicity, but culture represents an entire spectrum of life experiences and beliefs uniquely developed over the course of an individual’s lifetime. Through her respectful and genuine concern for the needs of her patients in a metropolitan Texas setting, Ardis Bush demonstrates what it means to be a culturally competent nurse.

Many states away, in rural Pennsylvania, Mona Counts demonstrates a similar commitment to culturally congruent nursing care, but the aspects she embodies are unique to her setting. Much of Appalachia experiences widespread poverty, and significant healthcare shortages have left many communities medically underserved. In areas like Mt. Morris, where the population is widely distributed across the territory, a single nurse practitioner like Mona may be responsible for providing primary care to several hundred individuals or isolated families. Her clients experience additional negative health care outcomes associated with low socioeconomic status, low education levels, and local mining and oil drilling industries. Mona recognizes that residents of Mt. Morris experiences a unique set of challenges and values that shape their cultural beliefs. She explains that “health in Appalachia is functional, not just absence of disease, which is different than what you see in metropolitan areas.” Her ability to engage members of the community both honestly and poignantly about issues of health and illness reflects a remarkable capacity for cultural congruence. Furthermore, her capacity for cultural immersion uniquely informs her ability to recognize and reconcile socially constructed beliefs about health with evidenced based care practices. While speaking with her patients, Mona gets on their level, both metaphorically and literally, reminding the viewer of the importance of meeting patients where they are.

In my own nursing practice, I aspire to uphold the principles of cultural competency set forth by nurses like Ardis Bush and Mona Counts. Presently, I am working in Holyoke, MA, at the Center for Education, Prevention and Action (CEPA), a drop-in center that provides outreach services and first contact health referrals to individuals in a health professional shortage area, CEPA targets marginalized populations like injection drug users, sex workers and homeless person for screening of sexually transmitted infections, HIV, and hepatitis. In partnership with the Holyoke Medical Center, CEPA provides counseling, referrals to substance abuse treatment centers, mental health services and medical care for individuals routinely disenfranchised by traditional health care systems. For me, cultural competency extends beyond an understanding of racial and ethnic values that inform health care beliefs; it also means aligning my moral compass to a respect for individual worth, an understanding of the psychosocial and physical effects of addiction, a suspension of judgment, a commitment to honesty and individual safety, and a passion for empowering communities often excluded from health care access. In the future, I plan to pursue a nursing career with the Holyoke Center for Behavioral Health, so I can continue to provide culturally congruent preventative care and reduce the cost of emergent care for this at-risk population.

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