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A Place for Faith

My First Experience of Cultural Competence in Nursing

Sumter, Melody MSN, BSN, RN

AJN The American Journal of Nursing: March 2017 - Volume 117 - Issue 3 - p 72
doi: 10.1097/01.NAJ.0000513297.42193.d6

A student learns there's more to the profession than clinical expertise.

A student learns there's more to the profession than clinical expertise.

Melody Sumter works as health and human services program manager in the Corporate and Continuing Education Division at York Technical College, Rock Hill, SC. Contact author: Reflections is coordinated by Madeleine Mysko, MA, RN: Illustration by McClain Moore.



I was a student in nursing school, completing my senior practicum and looking forward, with some trepidation, to using the skills I'd learned in clinical. Each night, I went to the medical intensive care unit (MICU) with my preceptor, Amanda, hoping to see a fascinating injury or illness or learn a new skill, such as ICP monitoring or how to titrate a new drip. But one night I witnessed something far more valuable.

Amanda and I were assigned to a patient in his early 30s, whom I will call Mr. Jones. He had a rare form of terminal brain cancer and his prognosis was bleak. A few days after we were assigned to him, Mr. Jones lost consciousness and was intubated. He had a loving wife and the cutest 10-month-old son.

It was heartbreaking taking care of Mr. Jones—although there was little hope that he'd regain consciousness, his family continued to put their faith in God to heal him. When the time came for the intensivist to discuss DNR status with Mr. Jones's wife, she was unable to accept it. To his family, accepting the DNR status meant they were giving up on his healing. They prayed continuously over Mr. Jones and had various clergy members come to pray for him.

The evening came when Mr. Jones's wife made the decision to accept DNR status and withdraw him from life support. When Amanda and I came on the night shift, we were forewarned that Mr. Jones would probably not make it through the night. In the early hours of the morning, he quietly passed away, with his wife and family by his side.

The tone of the MICU was somber, and I could hear the wails of Mrs. Jones from the glassed-in room. I learned that night that there were certain things that had to occur when a patient dies—a death protocol, in a sense. This protocol included completing postmortem care, sending the body down to the morgue, and contacting the funeral home of the family's choosing, all by the end of our shift. Hours passed, and the wife and family were still praying, crying, and singing over Mr. Jones's body.

Amanda and I entered the room to respectfully ask the family if they would mind relocating to the waiting room so that we could complete our nursing duties with the body. They explained that they couldn't do so because they didn't believe that Mr. Jones was really dead and were still praying that God would resurrect Mr. Jones's body, like Lazarus in the Bible. They had to be present with his body, praying over him, in order for God to work this miracle. I ached for their loss—and felt awed by the power of the faith they summoned in response.

As Amanda spoke with the charge nurse about the family's refusal, I heard snickers from some of the nurses at the nursing station. Though I'd been raised a Christian, I too had never witnessed such an act of faith. How could this family refuse to abide by the hospital policy? Wouldn't it affect other aspects of care? The charge nurse began to receive calls from the nursing supervisor regarding the availability of Mr. Jones's room. There were other patients in the ED who needed to be transferred to the MICU. Who was the priority in this situation, a grieving family or a critically ill patient who could possibly be saved?

When it was close to 5 AM, the charge nurse visited Mr. Jones's room to gently ask the family, once more, to relocate to the waiting room, but Mr. Jones's wife pleaded with the charge nurse to allow their family to continue to stay with Mr. Jones. Finally, about an hour later, the nursing supervisor called the charge nurse with the number of a vacant room on a closed floor of the hospital, where the patient and family could be transferred so they could remain with Mr. Jones's body.

Seeing this family practice their faith was encouraging for a young nursing student like myself—as was the nursing staff's acceptance and support of a belief that most of them didn't understand. The family expressed great appreciation to Mr. Jones's nurses. I feel honored to have been part of his care that night—and to have witnessed the culturally competent care he was provided. The compassion and understanding we provide for our patients far outweighs any clinical skill we could ever master. And while Mr. Jones was not resurrected on that spring morning, I do hope that his family remembers the care they received during their darkest hour as much as I do.

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