MODULE 35: THE CONCEPT OF CARING INTERVENTIONS
Clinical Example A
Mr. Bahdoon Osman, a 57-year-old man from Somalia, immigrated to Minnesota 5 years ago with his wife, son, and three daughters. Three days ago, he was rushed to the hospital for breathing and swallowing difficulties, the cause of which was a large tumor. Following emergent surgical resection of the tumor, Mr. Osman was diagnosed with stage IV esophageal cancer. The family is adamant that Mr. Osman not be informed of his terminal diagnosis, because Somali culture believes it is cruel to do so. The patient’s physician has presented his treatment options.
The charge nurse instructed Mr. Osman’s nurse, Joanne Williams, to speak only to the patient’s son about Mr. Osman’s care and not to his wife, explaining that according to Somalia traditions, the father speaks for the family when outside the home. When the father is unable to do so, another adult male in the family, often the son, takes on the responsibility. The nurse finds this instruction challenging, especially seeing the obvious pain the patient’s wife is in watching her husband suffer. The son tells Joanne that it is important that they reposition Mr. Osman’s bed “so that it faces Mecca.” Because Joanne does not understand the son’s request, she asks Mr. Osman’s wife for further explanation. His wife avoids Joanne’s gaze and does not answer. The son firmly explains to Joanne that his mother does not have a say in the matter and repeats the request. Frustrated and upset at the lack of respect for Mr. Osman’s wife, Joanne curtly responds by saying it is impossible to move the bed and leaves the room.
Critical Thinking Questions
Question 1
Did Joanne demonstrate caring? If so, how?
Question 2
How could Joanne have dealt with the Osman family differently?
Question 3
What strategies could Joanne have employed to address culturally specific healthcare issues for the family?
Clinical Example B
Mrs. Julie Briggs is a 29-year-old woman who has undergone a left-breast lumpectomy, which also involved removing cancerous lymph nodes. As a result, she has been admitted to the hospital for a brief recovery period. The first postoperative day, Mrs. Briggs’s nurse, Tomas Crespo, overhears an argument between the patient and her father, who is pressuring his daughter to have a double mastectomy as a preventive course of treatment because the patient’s mother lost her life to breast cancer at age 36. Mrs. Briggs tells her father that she and her husband hope to conceive a child within the next year and she desperately wants to experience the bonding experience of breastfeeding. As he listens, Tomas is reminded of his wife’s difficulty in breastfeeding and thinks the patient shouldn’t place so much importance on it. After the patient’s father leaves, Tomas enters the room and finds Mrs. Briggs crying. He pulls up a chair and asks her if she wants to talk. Mrs. Briggs says she’s fine and collects herself. Tomas squeezes her hand and informs her that he is willing to listen, but she shakes her head no. While changing the patient’s dressing, he allows a few minutes to pass before providing her with tips on how she can tend to her sutures when she is discharged in a couple of days, adding that he can also instruct her husband when he comes in later that evening. Upon completing Mrs. Briggs’s care, Tomas tells her that there are support groups for young breast cancer survivors like her and promises to bring the information to her before the end of his shift.
Critical Thinking Questions
Question 1
Did Tomas demonstrate presencing, empowerment, compassion, and competence in his interactions with Mrs. Briggs? If so, provide specific examples.
Question 2
Could Tomas have approached the patient’s dilemma differently? If so, how?
Clinical Example C
Mrs. Oden, the charge nurse on a medical–surgical unit, assigns extra patients to Celia Hammond, a new graduate nurse, in order to cover for a colleague who left unexpectedly to tend to a family emergency. Mr. Stephen Suskind, a 57-year-old man recovering from knee surgery, is among Celia’s patients. In the early afternoon, Mr. Suskind falls while attempting to make his way to the bathroom unassisted. The sound of the fall and his subsequent cry prompt Celia to rush into his room. As Celia helps Mr. Suskind to stand, Mrs. Oden appears in the doorway and criticizes Celia harshly for having neglected her patient, as well as for attempting to move him after his fall. The commotion attracts the attention of other nurses on the floor, who stand behind Mrs. Oden, observing Celia as she is being chastised. Afterward, Celia discusses the incident with an experienced colleague who has worked at the hospital for more than a decade. When Celia complains about having been publicly humiliated, her colleague advises her to “suck it up” and closes the conversation by warning her that “no one likes a whiner.”
Critical Thinking Questions
Question 1
What should Celia do next?
Question 2
How have Mrs. Oden, Celia’s nurse colleague, and others reinforced a culture of bullying?
Question 3
What actions might the nursing supervisor take to address incidents such as this one?
