Queridura: Latino Culture in Nursing

Health
Interview with Family Nurse Practitioner Katherine Reina 

 

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 Q : Tell the readers of Nightingale how you became interested in nursing and what steps you took to pursue a nursing degree.
A: I was exposed to healthcare at an early age. My mother was a single mom and my grandmother helped raise me. When she was diagnosed with a cirrhotic liver, she was in end-stage liver disease and in need of a liver transplant. Initially, I traveled back and forth from Puerto Rico to NYC when I was seven years old because my mother didn’t want my studies to be affected. One thing both my mom and my grandmother always instilled in me was the importance of education. I moved in with my godparents temporarily for two years until my mom could bring me to states. When I moved to New York permanently, I was nine years old and was in the process of learning English.
My mom went to school and worked which made it difficult for her to accompany my grandmother to all of her appointments. Sometimes I went with her and served as the translator between her doctors and my grandmother. It was thanks to talented healthcare providers and the gift of organ donation that I had my grandmother an additional eight years in my life, without a doubt the greatest gift I have ever received for she will always be the biggest inspiration behind all of my life ambitions and my nursing career.
I became interested in nursing while taking a certified nurse assistant course in high school. I had been exposed to nursing many times and really admired the strong role they played in my grandmother’s recovery. However, I never imagined I had the strength, competence, or stamina to become a nurse.

 

 

I remember her always saying “thank you” in her best English. While there were some staff members that were a bit rough with her, I mostly remember the nurses who took care of my grandmother and would let me help her

 
 While doing clinicals as a high school student, I was responsible for working with nurses and patients one on one. It was then, at 17 years of age, that I fell in love with nursing. I loved helping the elderly patients in the nursing facility with their activities of daily living and even more the stories they would tell me. In fact, a lot of their stories I still carry in my heart. One afternoon, I came home and told my mother that I no longer wanted to pursue a career in fashion design, I wanted to be a nurse. So I decided to look look into nursing schools and I opted for a traditional BSN program. While pursuing my BSN, one of our professors spoke to us about a Doctor of Nursing Practice degree. I never imagined that someday I would actually become a nurse practitioner or obtain a DNP. After about 3 years of working as an ICU nurse I decided to take the CCRN certification exam and I enrolled into a BSN-DNP program in the adult nurse practitioner track and completed the program part-time in 4 years while working full-time as an ICU nurse.
I’d like to share something that I think was the full circle experience for me. This past year I had the opportunity to care for a donor overnight. Donor patients are sometimes even more difficult to care for because they are hemodynamically labile and maintaining them “stable” for harvest can be a challenge. They also require frequent testing and titrations while the organs are matched and allocated. After almost six years of working in the SICU and caring for several donors, I had never had the opportunity to accompany the patient to the operating room. Having the opportunity to be present for the harvesting of organs was important to me because I wanted to experience every step of the process that had made it possible to gift life to my grandmother for an additional eight years. Whenever I cared for a donor, I always felt that I was actually taking care of multiple patients awaiting that similar gift. This past year I was able to experience the harvesting process. My shift had finished but I didn’t have to return that night so I stayed to for the full process. I remember tearing up for the liver harvesting and it hit close to home, I had so many mixed emotions. My career and my life in a sense felt like it had come to a full circle. I went from being the seven-year-old girl praying and anxiously waiting to hear if her grandmother had survived a major surgery and received a new liver to a caregiver directly involved in making it possible for someone else to have that same opportunity.
Q:  How was the transplant experience for your grandmother? What do you remember most about your interactions with nurses as you were present for her preparations for surgery and during her recovery?
A: My grandmother was a woman of faith who fell ill while helping care for me. She always spoke of God and would ask me “to have faith” in his plans. My mother sheltered me from seeing my grandmother in the ICU when she was first brought out from surgery. I remember that when the surgery was over I was told that she had made it through the surgery but now we had to wait until “she woke up.” She was extubated soon after and on her way to recover sooner than anyone had expected and I can honestly say that was the first time I had ever cried tears of joy. She amazed everyone with how quickly she recovered and was on her feet. I remember her always saying “thank you” in her best English. While there were some staff members that were a bit rough with her, I mostly remember the nurses who took care of my grandmother and would let me help her (however I could).  They took their time and really tried to communicate as best as they could with their limited Spanish and our broken English.
Maria was the only nurse who spoke Spanish and she always let more of us in the room with her-she understood how important family presence is for us Latinos, she could relate to us. I think that is why she always stood out to me.
In the summer of 2001, my grandmother turned 55 years old and told me one night that she was ready to go to God. That was too much for me to handle and I remember being angry with her. She was always a fighter, always strong and when she talked about dying I felt like she had given up. She always took great care of herself and we never missed an appointment. She had recently had a “check-up” I couldn’t understand why she was getting sick. One day she said she became lethargic, her eyes were sunken and slightly yellow. Eight years after my grandmother had received her transplant she became very ill again. We had been planning my quinceanera that summer. I recognized that yellow hue on her skin that had been a telling sign of something terrible years before.
When she was back at the hospital, there was Maria. She was older but still the same compassionate woman that had cared for her years earlier. My grandmother had a biliary obstruction which caused her new liver to fail. The surgeons tried everything from drains to small procedures, but my grandmother did not recover.

 

 

Latinos…We care so much about everything that we often find ourselves walking a fine line between being perceived as overly dramatic and being impassioned… For me as a healthcare provider and a Latina, “queridura” captures the essence of putting that passion into action or patient care…it’s a word that translates to “love”

 

 

I was fortunate enough to spend that last week with her. I slept in the waiting room and went home only to shower. Maria (her nurse) would always set up a cot for me in the waiting room and check on me to make sure I was okay for night. She not only provided the best care for my grandmother, she was there for us (the family) because, in a sense, we were in need of a lot of care too. She spoke our language, understood our family dynamics, and in a sense played a vital role in advocating for my grandmother’s health. I really admired everything about Maria. From the way she understood us to how she understood the medical complexities surrounding my grandmother’s care and all of the equipment in the room.
Some of the other nurses,however, were very unkind and often treated my family and me like we were a hindrance to their job. One nurse was so completely opposite from Maria; she was rude and found any opportunity to comment on how much she had to do and how there were always too many of us in the room making it difficult for her to do her job. She happened to be the nurse who was there the day my grandmother’s heart stopped beating. In the cruelest of ways, she started ripping leads from my grandmother and disconnecting equipment roughly. I asked her to be gentle and she told me “she can’t feel anything.” As horrible as that encounter was, it made me even more thankful for Maria’s caring and attentiveness. It put into perspective for me how important every nursing interaction is and the lasting impact they could have. At a month shy of 15, I had a good nurse/bad nurse perception wired into my memory.
In pursuing my own nursing career, I never forgot those interactions. It was my grandmother’s nurse Maria who taught me the first nursing lessons of empathy, compassion, and being present. She was there for my grandmother tending to the heavy life supportive equipment, giving her mouth swabs, hanging medications,  emptying drains, and keeping her safe. She was also there for us (the family) giving us hope, listening to our concerns, and keeping up strong. In my mind and in my heart those very first encounters with nursing made a lasting impression on me and ultimately shaped my own career years later.
Q: You discuss your ability to cross barriers in being bilingual in Spanish. How do you think this has enhanced your experience as a nurse? Besides an obvious challenge in communication, what do you see as being the biggest hurdle for non-English speaking patients in the American healthcare setting?

 

 A: I learned how to speak English fluently at the age of nine. It was easier for me than most of my family members because I was younger and less shy about my accent. It was definitely a struggle in the beginning and I was mocked for my broken English for quite some time, especially in school. However, it wasn’t just a matter of not speaking a language there was also a cultural component that was difficult to adjust to.
Growing up in Puerto Rico, there was never a sense of rushing to get things done or a lack of personal touch to even the most mundane interactions. The mailman dropping off the mail would turn into a conversation between  adults that lasted for what seemed like forever. The neighbors really cared for each other and would check in with one another in times of need. In fact, when my grandmother fell ill the entire community came together to raise funds for her surgery. The local news covered her story and mobilized support across the island to help my family financially cover some of the health care costs.
When I moved to New York, it was a culture shock for me. There was always a sense of not belonging, I never noticed chatty mailman in the neighborhood. Instead, there was always a sense of rushing from place to place and that seemed to be a common pattern; everyone I met  always seemed to be looking to “where to next.” I also grew up with very innocent views on the world and remember playing with dolls until I was about 14 years old which was considered “odd” amongst my classmates. I carried hello kitty pens, a pink backpack, and Lisa Frank notebooks in middle school where my classmates were concerned with acting like adults and getting boyfriends. I was happy being a child.
I think now reflecting on those first years of me living on the mainland US and learning English, I was able to pick up on cultural differences. Life here is often fast-paced. Even after moving to Connecticut, I have never felt that same sense of home or warmth I felt during my childhood in Puerto Rico.
It was only natural for me as a nurse to give back all of that warmth that I grew up accustomed to in each patient interaction. It has always been really important for me to make my patients feel that they are like family to me, that my heart and soul is into the care I provide. My Spanish speaking patients were often happily shocked to have a nurse that could speak to them in their language.  During the more difficult scenarios where families struggled with life and death it wasn’t me speaking their language; it was the familiality and warmth that made the difference.
Q: Being bilingual often goes beyond fluency in a foreign tongue. Tell us more about your approach to cultural competency and some of the more challenging parts of your job when it comes to certain biases (either on your part or the part of your patients and their families).
A: I recently started working for CliniSanitas and they emphasize on providing “queridura” between all staff members and more importantly with all of our patients. I bring this up because “queridura” is a word that translates into “love” in some Latin American countries. As a Puerto Rican American, I had never heard of the word until I began working for the company, but it makes perfect sense. It is really one word that sums up that warmth and sense of being like family that I have always felt was key to my patient care approach but was unable to articulate.
You are correct in saying bilingualism goes beyond speaking a language. It encompasses the mannerisms, the expressions, and that sense of unity that gives a group a sense of identity. I may be biased in thinking that Latinos are exceptionally passionate about everything. We care so much about everything that we often find ourselves walking a fine line between being perceived as overly dramatic and being impassioned over what may seem to others as the smallest of things. For me as a healthcare provider and a Latina, “queridura” captures the essence of putting that passion into action or patient care.
As a nurse, my colleagues often misinterpreted my passion for patient care as being overbearing or overly involved. Patients from what I remember really appreciated “my extra” efforts from painting their nails to playing Frank Sinatra while they took their last breaths as requested by their family members. I think in my case, having that cultural warmth made all the difference in the care I provided as an ICU nurse. As a nurse practitioner working in a system whose model builds on “queridura,” I feel I have found a home that enables me to care for patients with the same warmth, competence, and respect I’ve always considered most important.

 

 

Growing up in Puerto Rico, there was never a sense of rushing to get things done or a lack of personal touch to even the most mundane interactions. The mailman dropping off the mail would turn into a conversation between  adults that lasted

 
 Q: It’s great to see healthcare education expand into a multicultural setting, where the idea of cultural competence is essential in providing the best care possible. What do you think can be done to further implement certain curricula and policies that embrace diversity and a multicultural approach to providing quality healthcare?
A: I agree and think that the idea of cultural competence is essential to providing the best care possible. I think there is a valuable difference between cultural sensitivity and cultural competence. I think curriculums barely scrape the surface on these as it really has an impact on how care is delivered at varying levels. Cultural sensitivity is merely acknowledging that there are varying differences, whereas cultural competency refers to both the acknowledgement and putting into action a meaningful plan that meets the needs of the varying populations.
I feel that curriculums emphasize more on being culturally sensitive, but what does that really mean when the information is often presented as overly stereotypical characteristics of varying groups? For example, I remember that in reference to Native Americans, alcoholism is a big health risk amongst this group being included in our “cultural” awareness. For other groups, stoicism, superstitious behaviors, among other stereotypical ideas are the foundations of what I remember being emphasized in curriculums.
I think this practice ought to be replaced with an emphasis on true cultural competence that encourages health-care providers to identify and recognize their own biases. Ultimately to encourage providers be part of the solution to the many barriers posed in health care while promoting  caring attitudes that are understanding of all groups.
Q: What do you think is the biggest challenge facing nurses and/or other medical professionals right now?
A: I think one of the biggest challenges for nurses is the different entry points to becoming a nurse. As a result of continuing this practice within our profession we have created a sense of confusion as to the minimum educational requirements for becoming a nurse. Most often the public does not recognize the differences between an LPN, ASN, or BSN. They are all “nurses” after all. In my opinion, nursing would benefit from following other disciplines and standardizing the minimum entry level of education. There aren’t many professions that share this dilemma. A physical therapist, nutritionist, or occupational therapist all require a bachelor’s minimum education and these standards have become even more rigorous in some cases pushing for master’s or doctoral preparation. Nursing, which I believe is the heart of healthcare, still  continues to struggle in setting the same expectation so that there is only one minimum entry level to the profession.
I understand the initiation of the varying degrees and the distinct vital roles they once played during more difficult societal circumstances. I think that in moving forward the profession ought to reflect the current trends and needs of the population. I love nursing so much that I feel that in order to gain full respect as its own special entity in healthcare we ought to raise the expectation within our educational requirements.
An equally challenging problem we face is in health-care is the rate of burnout amongst nurses. There is a lot of supportive evidence that speaks to this phenomenon and I am not sure that we have any plans in action to minimize this at a systematic level.
Q: What is your ideal setting as a nurse? (For example, do you prefer the ICU, home care, etc.) Why?
A: This is really a difficult question for me because I have only practiced in an ICU setting, therefore, that would naturally  be my comfort zone as a nurse. While it is an intense and very demanding pace of care, I feel very humbled to have had the opportunity to care for critically ill patients and their loved ones and in return have so many of them touch my heart and become a part of me forever. My response here is completely biased based on my own experiences and in no way really captures the essence of the varying roles nurses play along the continuum of healthcare delivery.  For me, being a critical care registered nurse, there have been countless of occasions where I have used my own hands to restart dozens of  hearts, titrate life supporting medications, and provide comfort during really trying times for both patients and their loved ones. There is no greater sense of purpose for me knowing that I have had the privilege of being a part of their journey, and in return they become embedded in my soul and potentially changed me in ways they’ll never know. The ideal setting for me would be that the outcome of the care I provide is a source of a hope for those involved and more importantly reflects the genuine love I have for patient care.
Q: Working in the ICU is assuredly a lesson in quick problem solving and making a potentially life-altering decision in a matter of moments. What do you think non-medical professional readers of Nightingale should know and think about when they assess their own healthcare now and in the future?
A: Health is the single most important duty of every person. There are so many ways people can really take health into their own hands and improve their quality of life. We live in a day and age filled with so many options and having online access to so many of these is really advantage everyone should consider. Improving your choices now can really impact your overall health outcomes and potentially keep you from needing an ICU stay in the long run.
As a primary care provider, I think health is everybody’s business and we all responsible for our own outcomes. Therefore, I strongly recommend that people take the time to educate themselves on the health impacting trends that are out there and speak with their providers about healthy choices that are complementary to their lifestyle needs. It goes without saying that I feel it is important to follow and recommend evidence-based practice behaviors and keep up to date with our ever changing trends in care so that both medical professionals and non-medical community members can enjoy optimal health outcomes.

 

Q: As someone who is not a nurse (but who works with them in a professional capacity), I am constantly amazed by nurses’ abilities to manage and endure exceptionally stressful situations at work. What do you do to take care of yourself?
Nurses are exceptional members of the health-care team and I do believe that endurance is a key factor to their “superhero” abilities. We deal with really stressful situations both at work and outside of it. One of the best ways I have learned to manage my own stress is through exercise and pet therapy. I have a male Siberian cat named Remy and a female Siberian Husky named Kiomi. These two fur babies help balance out my hectic and often demanding lifestyle. Caring for them reminds me to take a step back and enjoy the simpler aspects of life. Their unconditional love for me is a constant reminder of how much greatness there is around me, even when so much could be going wrong.
I also love practicing self-care and self love on a daily basis through positive affirmations. Just telling myself “I am enough;I have everything I need” creates a positive shift in how my day turns out in the end. I love getting my nails done, a nice facial, or massage after experiencing some very difficult situations. These little luxuries help me to feel rejuvenated and cared for. I think it is really important for caregivers to remember themselves in the process of caring. After all, we cannot truly care for others if we are not well ourselves.

 


 

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Katherine had her first experiences with healthcare when she was seven years old and she witnessed the difference nursing made for her grandmother, a liver transplant recipient. At such a young age, she was in charge of translating what was said during the doctor visits, which made her aware of the significant language barrier that exists in healthcare. Since then, she has been determined to be a part of the solution.

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