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Running Head: COMMUNICATION

Communication: What are you trying to say?

Amelia Jenkins RN

Dixie State College, BSN

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Running Head: COMMUNICATION
Communication: What are you trying to say?

April Holland, the Director of the Pre-College Academy at the University

of Wisconsin in Milwaukee said, Embracing diversity is one adventure

after another, opening new paths of discovery that connect an

understanding to caring, listening, and sharing with others who are

different than ourselves" (University of Wisconsin, 2007). April Holland

was recognized for her contributions to counseling with an emphasis in

multicultural academic interventions. Just as she saw the need to

incorporate culture competence into her field of expertise so should

those in other fields, especially those of the medical field. When caring

for people from different cultures one must to take into account a

persons specific cultural needs, beliefs, language, and views about

health and healing. By taking a closer look at these individual parts of

what make a person a whole, one will be more likely to reach the

ultimate goal of a joint effort in the healing process. An example of

how this was not done, and could have been done better, was

documented in the book The Spirit Catches You and You Fall Down.

This book depicts a Hmong family and their young daughter who has

epilepsy, and the battle between the medical world and this family to

try to help heal this child. The following will be a look at how this book

can be related to culturally competent nursing in understanding

specific cultural needs; beliefs, language barriers, and views about

health and healing and how they affect those receiving care.
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Running Head: COMMUNICATION
Understanding Specific Cultural Needs

Where someone comes from has a lot to do with how they will interact

and communicate with others. In The Spirit Catches You and You Fall

Down the family is Hmong, these people have a long history of

nomadic type living because it was said that, they would rather flee,

flight, or die than surrender; that they are not intimidated by being

outnumbered; that they are rarely persuaded that customs of other

cultures, even those more powerful than their own, are superior

(Fadiman, A., 1997, p. 17). Even just this knowledge can help those

who would have had to find a way to work with this group of people.

First, it would have to have been recognized that force or persuasion

could not be used in order to have compliant patients. In the book the

staff of Merced Community Medical Center (MCMC) battled over just

such an issue in order to try to manage a young girls, Lia Lee,

seizures. As a result the culturally sensitive care this young child could

have received turned into a culture competition. When caring for

patients, the way they view their health will strongly be based around

the experiences they have had or developed from how they were

raised. Another example that demonstrates this is that in Hmong

culture women are thought of as lower in status in relation to men.

They still make decisions together as families, but the ultimate

decision will fall on the male (Fadiman, A., 2007, p.93). When caring

for a culture specific family it would be important to know this cultural

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Running Head: COMMUNICATION
custom, so that when giving instructions or information that directing

information to the head male of the family would show respect. Each

culture will have its own customs and ways of showing respect, by

becoming familiar with some of these gestures nurses can avoid some

unnecessary offenses.

Language Barriers

Language barriers can often be one of the first reasons communication

is not able to happen and people are offended. In the case of Lia Lee,

her family lived in an area where only a few people if any knew their

native language. As a result trying to communicate with doctors, staff,

and emergency personnel were very difficult and sometimes next to

impossible. Often vital information such as how to take medication or

when to have a follow up visits were not understood by family, and

therefore not done correctly. The only way the Lee family understood

what was going on some of the time was when they had a cousin, who

spoke a little English was with them (Fadiman, A., 2007). Talking

slower and more loudly does not help patients understand the

information or directions given. Nurses need to make sure that when

there are patients who do not speak the primary language that there

are means maded to find someone who can accurately and effectively

get information communicated. One of the first examples in the book

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Running Head: COMMUNICATION
of this is when Lia was first diagnosed, it was not epilepsy, but early

bronchiopnuemonia or tracheobronchitis (Fadiman, A., 2007, p. 26),

because at the time there was no one there who spoke Hmong. As a

result Lia did not receive the initial care she should have. One of the

primary roles of nurses are to be patient advocates, this can be done

by making sure to have the means to communicate accurately; can

patients speak, read, or write in their native language; can they

communicate by other means; are there videos or handouts that can

help these patients understand their diagnosis or treatments? These

are questions that need to be asked when working with patients whose

primary language is not English.

Beliefs

Strongly tied to cultures are their beliefs; this greatly influences how

things are done and interpreted. For the Lee family to have a daughter

who had what they referred to as the spirit catches you and you fall

down (Fadiman, A., 2007, p. 28), or epilepsy, was a great honor for the

family. To anyone else it may be strange to think this, but it was

because in the Hmong culture the shaman, or spiritual healer, was the

only one who could go into spiritual trances to know how to cure or

treat people. Often these spiritual trances were seizure like, it was

then thought that those who had epilepsy or seizure were going to one

day be a shaman, which was a great honor in their society. It was hard
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Running Head: COMMUNICATION
for the medical personnel to understand why the family thought this

disease was a good thing, and not a tragedy. In nursing, it is easy to

feel ones own culture and beliefs are better than someone elses.

Nurses need to take a careful look at their own biases and not let them

influence how they care for patients.

Health and Healing

Not all cultures view health and healing in the same way. As pointed

out in Transcultural concepts in nursing care (5th ed.), there are three

main ways cultures and people can view health: magico-religious,

scientific or biomedical, and holistic. Magio-religious is when people

feel a higher power is in control of whether they are healthy or are

being punished by becoming sick. Scientific or biomedical is a cause

and effect look at health: germs enter the body and grow, people then

get sick; people take medicine that kills germs, and people get better.

The holistic view of health is that peoples bodies need to be in

harmony with their spirits, nature, life, and so on; when something is

out of balance that is when people get sick (Andrews & Boyle, 2008).

Many cultures use different forms of these, even Lias family did; they

believed that herbs and spices could help heal certain sicknesses, but

they also felt that loud sounds around a baby or young child could

scare its spirit away temporarily causing them to become sick. If a

soul was lost for any reason they felt they could sacrifice an animal

and that would help to bring back the lost soul (Fadiman, A., 2007). In
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Running Head: COMMUNICATION
a study done about nursing and cultural competence was found, the

way that clients respond to nursing care services and the way that

nurses deliver those services (Bourque Bearskin, L., 2011, p.552-553)

completely depends on the individuals culture. Though the Lee family

accepted many of the services given at the MCMC, in the end they felt

that their personal beliefs about their own daughters care were not

validated or cared about. At one point the Lias mother and father

were even deemed unfit parents and Lia was taken away. Until,

nurses, and other medical professionals, understand how people view

health and healing; it will be hard to being to help medically treat them

in a ways that will be effective.

Bringing it Together

By becoming more aware of the different cultural backgrounds of those

who live in the areas in which nurses practice; they will then be able to

give better and more specific care. By also being a good advocate for

those who cannot communicate, nurses will demonstrate a respect for

the patients rights and desires. Understanding beliefs can give great

insight into why patients do or do not make certain choices, not only

about their individual care, but in general circumstances. Along those

same lines, how patients view their health and healing are important

tools to understand and incorporate into their plan of care so that the

patient feels that they are better able to heal. Just as April Holland

said embracing diversity [can be one] adventure after another,

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Running Head: COMMUNICATION
opening new paths of discovery that connect an understanding to

caring, listening, and sharing with others who are different than

ourselves (University of Wisconsin, 2007). Nurses have a great

opportunity to help people of different cultures to learn, grow and heal.

By being sensitive to peoples needs and cultures, not only will nurse

be able to help many more patients, but they will also be a great

influence for good in the lives that they touch.

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Running Head: COMMUNICATION
References

Andrews, M., & Boyle, J. (2008). Transcultural concepts in nursing care

(5th ed.). Philadelphia: Lippincott Williams & Wilkins.

Bourque Bearskin, L. (2011). A critical lens on culture in nursing

practice. Nursing ethics. 18 (4), 548-559.

Fadiman, A. (1997). The spirit catches you and you fall down. New York:

Farrar, Straus and Giroux.

University of Wisconsin. (16 July, 2007). UW System Outstanding

women of color in education awards. Retrieved October 29,

2011, from http://wsc.uwsa.edu/events/ woc/woc1999.htm#top.