NR 394 Week 8 Transcultural Nursing Reflection Example

The Question I Now Ask Before the Tray Arrives: A Reflection on Transcultural Nursing

Student Name

College of Nursing, Chamberlain University

NR 394: Transcultural Nursing

Instructor Name

Month Day, Year

The Question I Now Ask Before the Tray Arrives: A Reflection on Transcultural Nursing

A Tuesday Admission

Two weeks ago I admitted a man in his sixties who had emigrated from Bangladesh and was being treated for a foot infection and poorly controlled diabetes. At the end of the admission questions, before I left the room, I asked him three things I had never asked a patient before this course: what he thought had caused the problem, what worried him most, and whether there was anything about his religion, food or family that the team should know. He answered the first two briefly. To the third, he said that Ramadan would begin in four days and that he intended to fast from dawn to sunset, as he had every year. His insulin was scheduled with meals at 0800, 1200 and 1700. None of that had come up in the emergency department, and none of it was in his record.

Two Readings Side by Side

My opening post for this course described a Somali woman whose untouched meal trays I had written off as poor appetite until, on the third day, her daughter raised the question of halal meat. My reading then was clinical and immediate: an untouched tray means illness. I did not ask because the admission screen did not ask, and because I did not think of food as a place where belief and care meet.

With the Bangladeshi patient, my reading started differently because I asked before anything went wrong. Had I not asked, the likely sequence is easy to imagine: on the first morning of Ramadan he would have declined breakfast, I would have held his insulin or given it anyway, and either choice could have produced dangerous blood sugar. Instead, I told the diabetes educator and the physician on the first day, and they adjusted his insulin to fit a pre-dawn meal and an evening meal, following published guidance on diabetes management during Ramadan, and discussed with him the conditions under which his faith would excuse him from fasting if his health required it (Al-Arouj et al., 2010). He chose to fast with the adjusted plan, and his blood sugars stayed within his target range.

What Changed It

The question I asked grew out of the questions Kleinman et al. (1978) proposed for eliciting a patient's own account of illness, which I first read in the opening week and adapted in the second week's self-assessment into a commitment to ask three questions at every admission. My inventory score in that assessment placed me in the culturally aware range, with high desire and low skill, and I argued in that paper that desire meant nothing without a habit. The three questions are that habit. What I did not expect was how often the third question would produce something important. In eight weeks of asking it at every admission, I have learned about a fasting plan, a family member who needed to be present for any decision, a patient who wanted a female nurse for bathing, and a patient whose home remedy interacted with her anticoagulant. None of those appeared in the admission screen.

What Has Not Changed

I still make quick readings, and some of them are still wrong. Last week I assumed that a Hmong family's reluctance to consent to a surgical procedure meant they did not understand it, and I asked the physician to explain it again. The family understood perfectly well; they wanted to consult an older relative who was traveling. My reading was faster than my question, and I asked only after the physician had already repeated the explanation. In the account by Tervalon and Murray-García (1998), humility of this kind is a process kept up for a whole career, never a finished achievement, and this is what that means for me in practice: the habit of asking has changed some encounters, but it has not replaced the reflex of assuming, which still moves faster.

What the Other Weeks Added

The admission questions are the most visible change, but other assignments shaped how I use the answers. Writing the culture care plan for a mother doing the month taught me to sort what I learn into what to keep, what to adjust and what to change, rather than treating every cultural practice as either harmless or a problem. When the Bangladeshi patient told me about Ramadan, I did not think of the fast as an obstacle to his insulin; I thought of it as a practice to accommodate, which is why the conversation with the diabetes educator started from how to make fasting safe rather than from whether he should fast. The group analysis of Somali families in Minneapolis taught me to hold what I know about a group loosely and to expect individual patients to differ from it, which is exactly the mistake I made with the Hmong family, who did not fit the explanation I had formed. Each assignment added a step between noticing a difference and acting on it, and those steps are where my practice changed.

What I Will Keep Doing

The change I will keep is visible to anyone who reads my admission notes. Every admission note I write includes a line headed patient's own account, with the answers to the three questions, and the unit educator has asked whether the questions could be added to the admission template for the whole unit, which I will propose at the next practice council meeting. The second change is harder to see: when I notice myself forming a quick explanation for a patient's behavior, especially one that involves culture, I will ask the patient or family before acting on it. I cannot show that one on paper, but my charge nurse, who knows about the Hmong family, has agreed to ask me at the end of shifts whether I asked before assuming.

What Remains Hard

The question that remains hard for me is how to ask about belief without making patients feel singled out. I ask every patient the same three questions, partly so that no one feels targeted because of how they look or speak, but a white patient born in my town sometimes looks puzzled when I ask about religion, and a patient who has experienced discrimination may wonder why I am asking. Campinha-Bacote (2002) places cultural encounters at the center of developing competence, and each encounter teaches me something about how to ask. I have not yet found wording that feels natural to everyone, and I suspect that finding it is part of the lifelong process the course has described.

References

Al-Arouj, M., Assaad-Khalil, S., Buse, J., Fahdil, I., Fahmy, M., Hafez, S., Hassanein, M., Ibrahim, M. A., Kendall, D., Kishawi, S., Al-Madani, A., Nakhi, A. B., Tayeb, K., & Thomas, A. (2010). Recommendations for management of diabetes during Ramadan: Update 2010. Diabetes Care, 33(8), 1895-1902. https://doi.org/10.2337/dc10-0896

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003

Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251-258. https://doi.org/10.7326/0003-4819-88-2-251

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233