Physicians

Nursing, Maternity Care, and Cultural Sensitivity

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I was asked by The Maternal Health Task Force to guest-write an article in honor of International Nurses Day on May 12.  The following post was what I submitted.

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.

In conclusion…

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.

Is It Possible For a Physician To Remain Neutral When Addressing Patients’ Spiritual Concerns?

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This blog is the last of a four-part series covering the topic of spirituality and healing in medicine, specifically during end-of-life care, and is based on an article by Curlin Hall.

In a pluralistic society, most authors encourage physicians to remain neutral when addressing their patients’ spiritual concerns.  However, this is based on the assumption that it is actually possible for physicians to do so.  Neutrality is defined as “not aligned with or supporting any position; indefinite.”  Any human being, physician or not, cannot separate themselves from the specific traditions of knowledge and experience that shape their lives.  Even if a physician was brought up in an atheistic culture, he is bringing with him that lens for viewing the human experience and cannot divorce himself from that when a patient voices spiritual concerns.  Furthermore, as Hall states, “feigned neutrality will never be comfortable to the devout person, for whom ‘setting aside’ ones religious commitments would be a form of unfaithfulness.”

Neutrality versus Candor

The question for physicians should not be “How do I remain neutral?”  The question should be, “How should a responsible physician address genuine disagreements regarding religious matters in such a way that he and the patient can respectfully negotiate a mutually acceptable accommodation?”  This type of dialogue requires candor.  The physician need not divulge his entire spiritual paradigm.  However, he should be aware of which judgments are part of his professional consensus and those which are derived from his personal belief system.  Moreover, that distinction must be made clear to his patients.

In conclusion, it is of my opinion that neutrality among physicians when addressing spiritual concerns is not possible.  Neutrality among physicians should not be expected or encouraged.  Instead, physicians should be encouraged to address their patients’ spiritual concerns with a spirit of wisdom and candor without neglecting their own belief system.

Does Addressing Spiritual Concerns Threaten Patient Autonomy?

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This blog is part three of a series covering the topic of spirituality and healing in medicine, specifically during end-of-life care, and is based on an article by Curlin Hall.

 

The power dynamics within the patient-physician relationship have been a topic of many studies and discussions over the past few years.  Power, within relationships, has two components: the ability to form one’s will to make decisions and the ability to carry out or effect one’s will.  These components come into play within the patient-physician relationship giving the physician immeasurable authority when it comes to patients’ decisions regarding care and treatment.

In light of this, many authors state that physicians should not address their patients’ spiritual concerns because it automatically threatens their patients’ autonomy.  The only exception is if such concerns or ideas conflict with “rational, evidence-based medicine,” in which case a physician is obligated to challenge the ideas out of his commitment to beneficence.  It seems that there is a double standard or secular bias when it comes to addressing a patient’s spiritual concerns.  For example, are not physicians constantly using their power to persuade patients to stop engaging in deleterious activities such as promiscuity or smoking?  Is that any different than a physician dissuading a patient from simply praying about their treatment options and encouraging them to take the recommended path of treatment?

Autonomy versus Respect

Despite the insistence that a patient’s autonomous rights need to be upheld, it is rare that a patient does not ask and receive personal recommendations for treatment after options are presented by his physician.  If a patient voices spiritual concerns regarding treatment options, his physician should be able to engage these concerns freely in a way that promotes respect for the patient’s views while maintaining their autonomy.

Open dialogue between physician and patient where spiritual concerns are addressed should never be considered a violation of patient autonomy.  Physicians should never coerce any patient make any decision against their will, but neither should they neglect a patient’s deepest spiritual concerns.