Vol. 5 •Issue 8 • Page 12
Melting Pot
Nurses Bring Cultural Diversity, Awareness to New York Hospital Queens
The ethnically diverse nursing staff at New York Hospital Queens hails from many countries around the world. They reflect the rich cultural heritages of the community in which they work. According to the Census Bureau, Queens is widely considered the most ethnically diverse community in the United States, with more than 160 nationalities represented and 100 languages spoken. More than half of the 2.2 million people living in Queens are foreign-born, with more than one in three residents coming from an Asian country.
Michaelle Williams, MA, RN, CNAA, senior vice president of nursing at New York Hospital Queens, said she enjoys working in such a culturally rich institution.
“It makes the work environment very interesting because we have so many cultures at New York Hospital Queens, and it’s a constant learning situation. We see differences in everything from people’s perception of healthcare to their coping mechanisms for pain.”
PAIN MANAGEMENT
Nurses from various countries who work at New York Hospital Queens describe pain management as an important part of culturally sensitive nursing care. Boulong Farrell, LPN, a labor and delivery nurse who once served as a midwife in Thailand, explained that women from her native home typically do not request pain management treatment.
“Women in Thailand don’t ask for help too much,” she said. “If they have pain, they’ll try to tolerate it. Especially in the labor and delivery area, they don’t like to ask for pain medications; they’ll try to do it naturally. If they can’t take the pain any more, then they’ll cry out.”
Allan Calvez, LPN, a med/surg nurse from the Philippines, said the same behavior is true of many Filipino patients. “We’re not a bunch of complainers, but we’ll ask for medication if we’re in a lot of pain,” he said. “Otherwise, we try to bear it.”
Samantha Nannapaneni, LPN, an IV team member from India, explained that her fellow countrymen might convey pain messages indirectly. “Most of the older patients will express pain through their family members, and a female patient will communicate through her husband. So, if the husband is sitting there at the bedside, the woman will not respond directly to the doctor or nurse. She’ll talk to her husband, and he’ll relay the message to the healthcare professional.”
Jamaican patients, on the other hand, tend to be pretty straightforward. “We’re not going to cry a lot, but if we’re in pain and need medication, we’ll ask for it,” said Dorrie Linton, LPN, a pediatric nurse from Jamaica.
DIFFERING VIEWS OF WESTERN MEDICINE
In many cultures, the New York Hospital Queens staff explained, there is an underlying belief that Western medicine is not effective, or that it should be used only as a last resort.
“Many Guyanese have a major problem with Western medicine,” said Indira Merced, RN, an ED nurse from Guyana, South America. “They use a lot of herbal medicines and believe that Western medicine does not work very well. They’ll try these home remedies before they come to the emergency room, believing that you can’t treat a cancer of the stomach, or any other area.”
Li Jun Zhou, BSN, RN, who works in the surgical ICU, explained that many new immigrants from China are frightened of the American healthcare system.
“They often have no insurance and they don’t trust Western medicine, so they’ll go to the herbal store, perhaps have some acupuncture to treat the problem, and then they may come to the hospital after they’ve tried everything else,” Zhou said.
“A Chinese patient who follows his cultural beliefs and traditions may not cooperate at first with our healthcare practices,” added Calvez. “A Chinese doctor can explain what’s going on, and help the patient understand to put aside cultures and traditions during his hospital stay. The patient may come to believe, ‘Maybe I’ll feel better and the healing process will be faster if I listen to this person.'”
THE ROLE OF FAMILY
It’s important for nurses to understand the role of family members in healthcare decision-making within certain cultures.
For example, if an Indian female is admitted to a hospital “she needs some privacy, and she’ll prefer a female doctor so she can express her feelings and emotions,” Nannapaneni explained. “Traditional patients from India will also want to have their family members with them at the bedside.”
Filipino families are also highly involved in their loved one’s care, according to Calvez. For this reason, restricted visiting hours often have a negative effect with this population.
“When one of our family members gets hospitalized, we usually take turns staying with the patient,” he explained. “That shows respect, love and concern. We feel upset if we have to leave that person alone [in his room], so we’ll speak to the nurse about letting one person stay after visiting hours are over.”
“Families of Indian patients not only expect to stay with the patient, they also want to help the nurse by giving the patient a bed bath or assisting with the patient’s feeding.” Nannapaneni added.
POST-PARTUM ISSUES
Cultural differences also extend to the mother/baby unit. Carol Wolf, LPN, a staff nurse there, said that nurses need to be cognizant of their patient’s background and family dynamic in order to give appropriate care.
“Americanized mothers will do a lot of care with their babies, and the fathers also participate,” she explained. “But some Asian or Indian women may rely more on their mothers or mothers-in-law to take care of the infant. We have to encourage [these patients] to take a more active role, to participate in the teaching sessions. Some fathers from India, China or Korea may kind of stay back, but the younger or Americanized dads might do more with the baby, especially when other family members aren’t around.”
Sometimes, family members try to do too much for the new mother, Wolf said. “Family members may not want to let the mother get out of bed, or we may find them spoon-feeding a mother after a vaginal delivery.”
When such situations occur, nurses on the unit often conduct patient and family teaching to help everyone understand the importance of early ambulation.
Traditional Indian women often cover their heads and ears after the baby’s birth, wrap cloths tightly around their abdomens, drink hot tea and cross their legs to compress the uterus, Nannapaneni said. However, she’s starting to see some changes in childcare with this population.
“In India, the woman takes care of the baby, but she needs privacy in which to do so,” she added. “But the younger generations of men do take care of their babies more than they used to.”
It’s not respectful to touch Thai women on the head or the lower parts of the body, unless it’s medically necessary, Farrell said. Men of this country take a more conservative approach to perinatal care.
“Husbands won’t show affection with pats or kissing — it’s not polite,” she said. “They feel like they have to be tough, although the new generation is sometimes more affectionate.”
FOOD AND DRINK
Patient menus at New York Hospital Queens include dishes from a number of different countries, and food service personnel try to accommodate cultural preferences.
After learning that many patients declined the ice water placed at their bedside, the hospital began providing hot water on the nursing units.
“Thai women also like to have hot tea or hot water after birth, because the hot tea helps to clear out the body,” Farrell explained.
Warm water is also preferred in Indian cultures, Nannapaneni said.
“Indian people fast on different days, and at certain times of day,” she added. “Sometimes, they may avoid certain foods like eggs.”
‘THE SAME UNDERNEATH’
In spite of their diversity and their sensitivity to the needs of patients from other cultures, the nurses at New York Hospital Queens are keenly aware of the universal nature of people from around the world, whatever their country of origin.
“Being a third-generation European-American, I have to say we’re all still very much the same underneath,” said Donna Darcy, MA, APRN, BC, of the nursing education department. “We all appreciate love, kindness and respect for our body parts, as well as privacy.
“As we’ve embarked on this cultural diversity learning process, we’ve actually learned how much we are alike in what we expect from the people who care for us.”
Sandy Keefe is a nurse, freelance writer and regular contributor to ADVANCE.
Celebrating Cultural Diversity
New York Hospital Queens has made cultural competency a prerequisite for staff. Although a great deal of cultural sensitivity developed as the hospital staff became more representative of the community, there was still a need for strategic planning and education.
“We’ve had to embark on a very long, tedious process of sensitizing our employees to the various cultural needs of different ethnicities,” said Paul Pickard, senior director of public affairs and marketing.
TESTING CULTURAL COMPETENCY
As part of that process, Donna Darcy, MA, APRN, BC, of the nursing education department, was asked to develop a cultural diversity educational plan. “I’m a Queens native, so I knew I needed the help of nurses from other cultures as well as members of the community,” she noted. “Working together, we came up with a self-learning module with a test at the end that is now part of our hospital orientation.”
Titled “Meeting the Challenge of a Multicultural Environment,” the module includes sections discussing the impact of culture and religion on language, health practices, illness beliefs, birth customs, and death and dying rituals. Each section contains practical information for hospital staff caring for Chinese, Korean, Indian, Latino, Arabic, West African and Russian patients and their families. The program also lists available resources for staff members who encounter issues related to the cultural diversity within the facility.
“We also have what we call NYHQ College, which offers free classes taught by instructors from local colleges and communities,” Darcy said. “They’re open to all employees on their work time, and we’ve offered classes specific to the Chinese, Korean, Hindu and Muslim cultures, among others.”
All of the hospital’s patients’ rights and educational literature has been translated into Spanish, Korean, Mandarin, Greek and Russian. In addition to the many multilingual employees throughout all hospital departments, the facility boasts an AT&T Language Line on every floor. The process of translating patient information materials is ongoing, with Braille and sign language as the latest additions.
DISPLAYING THEIR COLORS
The nurses at the hospital are proud of their cultural diversity and express their pride each year during National Nurses Week.
“One year we hung up what seemed like hundreds of flags with the picture of a nurse from that country on the back,” said recruitment manager Laurie Cariglio. Another time, the nurses gathered recipes from various countries and cultures for a cookbook that was published internally and given to nurses as a gift.
—Sandy Keefe, MSN, RN
