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Perspectives: Rehabilitation Nursing Reaches Across Cultural Barriers
In the Philippines people have a rather negative view of rehabilitation hospitals. We think of admission to a rehabilitation facility as admission to a detoxification facility for substance abusers and alcoholics. I can still see the concerned look on my father’s face when I told him I had been hired by a rehabilitation hospital in the United States. I went to great lengths to explain what my work would involve, but privately I also worried about practicing in this setting. I was nervous about working in the United States, and I wondered whether my patients and coworkers would understand me.
One of the first patients I cared for in the United States was a Liberian woman who had become tetraplegic after being struck by a car in Liberia. The silver lining for her was that the driver who hit her belonged to an international humanitarian agency that financed her hospital stay in the United States. It was also fortunate that she had two nieces who worked in Massachusetts.
While hospitalized in Liberia, she developed contractures on both upper and lower extremities, and to further complicate things, she had Stage IV pressure ulcers on her right and left trochanters and sacrum. She was completely dependent for care, feeding, bathing, turning, and even scratching her head.
The nursing staff called her “Mama” because she talked so longingly of her children who were still living in Liberia. She did not trust the hospital staff in the beginning. Her physician would come into her room and talk to her, but she would just stare back at him, sometimes giving monosyllabic answers. I could see the apprehension in her eyes. She looked distrustfully at me when I gave her medicine. Stretching, turning, and repositioning had to be done slowly and carefully, but even then, those movements caused her excruciating pain. I was careful not to make any gestures that would be perceived as threatening to her, and I took care that my tone of voice was gentle and calm.
I had to develop a rapport with her and win her trust. Coming into the room with her dressing supplies was always difficult. She understood it was necessary, but still she looked at me with an expression that communicated how much pain she experienced daily as a result of cleaning the wounds. Eventually, we gave her analgesics before dressing changes and before therapy in order to make these tolerable for her.
Mama would ask me to explain each medication I gave her. What are the pills for? How do they work? Do I really need all these medicines? What would happen if I didn’t take them? I patiently answered the same questions each day to ensure that she would take her medication.
The day came when she finally decided she could trust me. Although this was welcome news, it complicated things in other ways. She decided she would only take her pills from me and wanted me to work 24/7. I worked with other team members to help explain to her what her plan of care entailed and why a particular device would help her. Gaining her trust facilitated the work of her primary team. We were able to talk with her a little more freely, get her to stay up on her chair a bit longer, have her use her mobile arm support more frequently, and help her reposition with less and less discomfort. We were making progress.
Two of Mama’s most endearing traits were her love for her family and her faith. She would talk about her children all the time, and how she wanted to see them. Her nieces who worked nearby could not visit often, so we tried to make up for it by spending time with her. She always wished her children could come from Liberia and visit her. We encouraged her to talk about them. She also believed that she would get better. We paired her prayers with encouragement for her to participate more in her therapy sessions.
She prayed earnestly for progress and improvement. She accepted that she may never be able to walk again, but she also gave us a big smile when she could start feeding herself. Mama’s wounds healed very well. She said she was thankful that we repositioned her even when she didn’t want us to. Mama sat up on her chair longer and felt better because of it. She was also more open to people, especially the staff. She was still a little anxious when introduced to new devices, such as a new leg splint, and when meeting new people, but we did not see the fear and distrust in her eyes anymore.
Most importantly, she became capable of directing her own care. When she was finally discharged to a long-term care facility, she was sad to leave, but we tried to reassure her that there would be caring people there who would attend to her needs.
Mama is someone I could relate to because I could draw parallels in our lives. We both came from foreign countries, regardless of the circumstances that brought us here. We have our own families, which we think about all the time, and we each have our own faith from which we gather strength. Like her, I was apprehensive of being in a country whose culture and practices are different from my own. I had been concerned about the adjustments I might have to make while working here, but I soon discovered that any roadblocks were minor.
Coming into rehabilitation nursing with an open mind, I discovered I liked working as a rehabilitation nurse. Helping people reach their optimal level of function reinforces that caring for people transcends race and culture. Seeing them go home, better equipped to face life after hospitalization and reintegrate themselves into the outside world gives me a feeling of satisfaction from a job well done. I know that I will discover new skills that I can use in my practice. I also know that I will continue to play an integral part in helping patients achieve their goals toward increased independence. That is why I continue to work in and enjoy rehabilitation nursing.
About the Author
Sophia Rivera, BSN RN, is a staff nurse in the spinal cord injury program at Spaulding Rehabilitation Hospital in Boston. Her article placed third in the 2005 Rehabilitation Nursing Writers’ Contest.