Jenefer Burslem, University of Victoria Nursing Student
Reflective Practice Narrative (2005)

For this reflective practice narrative, I had thought to write about my experience following a patient through the entire continuum of care they experience in the Heart Health program. It was an amazing experience to have been able to follow one patient from same day surgical admit and the pre-op teaching to the OR, to CVU and finally back to the ward. However, there is one experience that I have had on 4 West in the past few weeks that had been praying on my mind ever since. I think this experience would be the more valuable experience to explore in further depth. I apologize in advance if this narrative ends up seeming a little disjointed. The thoughts I have on this subject tend to jump around on a tangential basis.

The basis of this experience is a patient I had. This one patient has led me to challenge my assumptions and judgments that I make and have, all in one fell swoop. It all began in while checking my charts in the morning when on the cardex it mentioned that the patient was "an elderly native male." Automatically with this one sentence I already had assumptions and made judgments on this man. More so than I ever would have done given any other patient. It also made me question why it is that it had to be brought to my attention that the patient was Native. Why does it never read "elderly Caucasian male"? I went into the patient's room with the power of pre-made assumptions colouring the interaction I would have with this patient. The patient was, in fact, an elderly Native male who had had a carotid endarterectomy and was in fact doing very well. It was in talking with this man that I found out that he was a linguist and could speak 11 different languages. The thought that ran through my mind before I could even think about what I was thinking was, "This man is a linguist??" It was not until after I had had the thought that I could really assimilate what had just happened.

I took a class in the summer semester at UVic about culture and health. It was all about how our entire way of being is coloured by our experiences as part of the majority group. It was through this class that I was able to realize that my entire upbringing, not intentionally, has shaped how I view people. I grew up in a small town with a fairly large Native population. From my experience, the Native people were always looked on in derogatory ways. Whether I realized it or not at the time, I helped perpetuate these ways by thinking along the same lines as well as speaking in derogatory ways about the Native people. I never thought of myself as being racist; however I guess I did see myself as being superior in some sort of way. There were always stereotypes and derogatory names to be perpetuated. The classes at UVic really helped me see that it is these types of values that are instilled at a young age that perpetuate the distinction between First Nations and Caucasians. It also helped me recognize that the thoughts and stereotypes I had will always be there and that the biggest thing is to be able to recognize that type of thinking. It is with recognition that we can attempt change.

I guess the biggest learning that came with this situation is that I still do have stereotypical thoughts and pre-made assumptions. Because my patient was First Nations does not mean he cannot have a university education and be able to speak 11 different languages. I had thought that the classes I have taken had helped me to avoid making such snap judgments. I realize now that you can never avoid making snap judgments. They are made unconsciously, which is why they are snap. What does this all mean? It means that this situation has only cemented that the stereotypes I have play a major role in my thinking and with my interactions with clients. One big question I have is how does this way of being really affect my interactions with my client? Did my amazement at this client being a linguist show? Did he realize that I was surprised because he was First Nations? How would this affect any further relationship between us? I have always considered myself to be able to create really solid relationships with my clients. It is upsetting to think that something pretty much out of my control could have an effect on my patients and our relationship. I wonder if this man has experienced similar reactions. How does this affect him? There are so many questions and no real answers.

I guess that the only direction to go from here is to recognize that thoughts such as the one I had concerning the patient I described are always going to be there. It is an understanding that I cannot change what has been ingrained. What then can I change? What is going to change is the acknowledgment of the assumptions and stereotypes in a way that does not affect client care. I do not want to endanger my clients and our relationships by being a narrow minded individual who is set in their ways. I want to be able to be me and to create relationships with any and all patients, not dependent on race or culture. I want to be able to learn from my patients and hopefully they will learn from and about me.

Our RNABC competencies speak about providing care that demonstrates sensitivity to client diversity as well as demonstrating attitudes that contribute to effective partnerships with clients. What I think that these competencies do not take into account is what I have just been articulating (hopefully in some sort of understandable fashion). It is difficult to demonstrate sensitivity to client diversity if we are stuck in our own stereotypes and assumptions about who those clients are. It is difficult to demonstrate an attitude that creates an effective partnership when innately we may not see those patients as being on the same level as us. Intercultural education, in that way, is so valuable. I am so thankful that I was able to take a course which made me confront myself in way I had not even thought of. I believe that it will be so beneficial for my practice.