Illness Narrative Essay
by Marie Jimenez, SPN
Part A – As a future licensed practical nurse, living in New York City, it is important to develop cultural awareness in getting to know our future patients. After reading excerpts of More Than a Case by Professor Ting Man Tsao, I was disappointed at the way the healthcare providers failed to provide optimum healthcare to the patient, baby Ann. It made me realize how important therapeutic communication, transcultural communication, and cultural awareness are vital in the nursing profession.
Culture & Language – Baby Ann’s mother is from Vietnam although, according to More Than a Case, “she spoke Cantonese, Vietnamese, and some simple English…[She] was not able to deal with complicated situations that demanded difficult English.” Regardless of the amount of English that baby Ann’s mother used, there are ways to therapeutically communicate with patients and their family members.
Since baby Ann’s mother is Vietnamese and spoke Cantonese, she could have been mistaken for someone who is Chinese. That is an issue that should be addressed because I believe that we should not stereotype Asians as only being Chinese. There are several countries that represent Asia including Japan, Korea, Vietnam, Malaysia, Indonesia, and the Philippines.
Development of Self-Esteem – Throughout the story, the self-esteem of baby Ann’s mother gradually declined. In the beginning of the story when baby Ann had some rashes, her mother was always attentive and brought her to the Emergency Room. Regardless of the cultural and ethnic backgrounds of potential patients and their family members, the hospital represents a place where healthcare providers help people get better and recover from their illness.
Towards the end of the story, baby Ann’s mother was in despair. According to More Than a Case, baby Ann’s mother was “aggrieved over how the hospital” treated baby Ann. Despite the mother’s anger at the healthcare system, she persisted through obstacles against her.
Strengths & Weaknesses –The strengths of baby Ann’s mother was that she was very willing, determined, and had a lot of integrity. From More Than a Case, baby Ann’s mother persisted to tell the nurse to wait and “explain the possibility of
an allergy to the doctor.” Despite the language barrier, the mother’s strength contrasts the ‘stoic’ perception of Asian
women. Baby Ann’s mother is not indifferent to her emotions.
The weaknesses of baby Ann’s mother was that she was unassertive, powerless, and had a self-defeating attitude. Baby Ann’s mother should have questioned the switch of medications from Amoxicillin to Ampicillin. From More Than a Case, baby Ann’s mother did not question the doctor as the doctor explained that “the same medication had been applied to [baby Ann] in the last hospital stay and everything had been OK.” Baby Ann’s mother should have been more assertive and asked more questions to the doctor instead of being intimidated by authority.
Part B – According to Catalano, “Nurses who work with non-English-speaking clients need to develop alternative ways to measure a client’s understanding rather than depending only on a verbal response” (Catalano, 2006, p. 423). Communication co-exists both verbally and non-verbally. As future nurses, we should be able to utilize the ways in which a patient expresses themselves and the message that they are trying to send. The goal is to understand the patient by gathering all sources of information and clues the patient might be sending. In addition, as future nurses, we should also get in
the habit of making sure that our patients understand the rationales behind procedures and medications that are given to them. Failure on one or both sides to communicate effectively leads to miscommunication and legal issues.
If I was one of the nurses taking care of Baby Ann from May 23 to May 27, I would have done things a little differently to better address the concerns of the mother and the needs of baby Ann.
May 23 – First, based on More Than a Case, on May 23, I would have reported baby Ann’s condition immediately to the doctor when she turned “purplish black.” For a baby to abnormally turn to this color should be an immediate sign that something is wrong. Second, on May 23 when the doctor concluded that baby Ann’s condition was not an emergency, baby Ann’s mother cried. According to More Than a Case, the doctor “didn’t do anything. Nothing. No special care was given…The nurse talked to the same doctor, who repeated what he had told baby Ann’s mother.” If I were the nurse, I would not have repeated what the doctor said to baby Ann’s mother. Instead, I would have spent time to listen and comfort the mother with open-ended questions such as “I see that you
are upset and bothered. Can you tell me what is bothering you?" From asking open-ended questions, I believe that would
have reduced the mother’s anxiety and would prevent her from
In nursing, the profession calls for an interactive and collaborative effort between all healthcare professionals in achieving one goal: to effectively provide the best possible care for the patient.
May 27 – Baby Ann’s mother became concerned about her daughter when she was in the ICU. She was desperate for her daughter to see a doctor promptly. When baby Ann’s mother saw the doctor, the doctor dismissed baby Ann’s mother and baby Ann’s symptoms. According to More Than a
Case, “the nurses nearby were shaking their heads though they didn’t say anything audible.” If I were the nurse, I would have pulled the doctor aside and suggest that he should find other ways to explain to the mother what is going on with her daughter in a polite manner. As a collaborative team, we should have open communication with our colleagues about the things that should be more appropriate to do in certain situations. Secondly, I would approach baby Ann’s mother in a
way that she does not feel any more distressed and threatened. I would not give her false reassurance. Instead, I would use therapeutic communication and tell her that we are trying the best we can to alleviate baby Ann’s symptoms.
The difficulties faced by the nurse was when baby Ann’s pediatrician wanted to speak to the doctors in the Emergency Room. According to More Than a Case, “The nurse was upset, arguing it was not appropriate for an outside doctor to ask their doctors to call back.” Most likely, the nurse wanted to intervene and allow the pediatrician to talk with the ER doctor, but was uncertain of her role as a nurse to allow that to happen because in every hospital there are certain protocols and procedures that have to be maintained. Deviation from those protocols and procedures leads to further complications and legal issues.
Overall, it is important to think about how culture has a definite impact on healthcare and the nursing profession. It is always encouraging to read at the back of some of my textbooks how to say medical terms and questions in several languages such as Spanish and Cantonese. This is important
because it should serve as a catalyst to better understand our patients.
Catalano, T. J. (2006). Nursing Now! Today’s Issues,
Tomorrow’s Trends. Philadelphia: F.A. Davis
Tsao, M. T. More Than a Case. LaGuardia Community