Beyond My Expectations

I begin my shift on the renal ward. After taking report from the night nurses who are from Canada, New Zealand, South Africa, and Jordan, I grab a thermometer and head down the hallway and knock on the closed door of my patient's room. Because there's a sign on the door with a female image engraved on it, I expect to find a woman inside. As I enter, my patient rouses and quickly covers her face, either with the blanket on her bed or her veil. Her hair is already covered by a black scarf. Once she realizes I am a woman, she may uncover her face, depending on how comfortable she feels about exposing herself to me. Some women, usually the older ones, rarely remove their veils, keeping their faces concealed even after they get to know me.

But things are different whenever I enter a male patient's room. While a man usually prefers to wear his head covering (known as a ghuttra), because it is not culturally necessary for him to do so, he does not cover his face.

This behavior was only one of many practices I had read about, but had not personally witnessed until I ventured abroad to work as a staff nurse in Riyadh, the capital of Saudi Arabia. Before making my move to the desert kingdom in 1998, I had composed a mental list of what I expected to gain from my experience. While I suspected I would gain insight into the differences between the American culture I left behind and the Saudi culture in which I would be living, I didn't expect to learn about a variety of other world cultures.

Immersed in a New Culture

I became a member of a nursing team composed of people from all over the world that provided care to predominantly Saudi Arabian Muslim patients. This multinational team faced the daily challenge of keeping in mind the culture of their patients, as well as those of their colleagues.

The orientation program provided incoming staff with an introduction to the role the local culture would play in everyday work. For example, the practice of segregating the sexes in society is maintained in the hospital. So while women can provide nursing care to both sexes, male nurses are generally assigned only to male patients. This means that the allocation of staff can prove to be challenging if the patient census consists of more women than men, and too many male nurses are on duty.

In Saudi Arabia, the Muslim religion is an integral part of daily life, and one of the primary duties of Islam is to pray, at specific times, five times each day, facing in the direction of Mecca. As a result, a patient's need to pray must be accommodated in his treatment schedule, and I had to learn to avoid walking in front of my patients during their prayers.

Unexpected Learning

When I decided to work abroad, adding new English words to my vocabulary had not been on my list of expectations. Indeed, while I intended to learn enough Arabic to communicate with my patients, I didn't expect to discover so many ways to say and mean the same thing in English!

For example, rather than give report about the patients at shift change, my British nursing colleagues gave me "handover." To find out which shifts I was due to work, I checked the "off duty" instead of the schedule. Taking a patient's vital signs became synonymous with doing his observations, or "obs," which is the term used by my counterparts from the United Kingdom, Australia, and New Zealand.

In addition to language differences, cultural differences in work patterns and communication styles can also lead to misunderstandings among staff. While I referred to myself by my first name in the workplace, which is a common tendency among North Americans, some nurses from other cultures viewed this practice as unprofessional and addressed each other in a more formal manner using their family name.

In the hospital setting, all communication and documentation relating to patient care is conducted in English. But nurses who spoke English in addition to their native language frequently used their native tongue to communicate with colleagues who spoke the same language. It's a practice that sometimes led to feelings of exclusion among native English- speaking nurses, particularly if they were the minority on duty.

Speaking Up

As a nursing student, I was always taught to challenge approaches to patient care that I considered inappropriate or unsuitable, such as a questionable medication dosage or an ineffective wound care regime. I was taught that if I saw an error, I should speak to my nursing supervisor or the physician. However, there were differences here, too.

Nurses from cultures that place a high value on status, particularly status based on sex or occupation, commonly hesitated to question decisions made by those "above" them. Consequently, a nurse who questioned a doctor's order was sometimes viewed as being aggressive, while a nurse who didn't take the initiative to challenge a questionable order could be considered complacent or indifferent to the needs of the patient.

But while these differences sometimes caused problems, they also created unexpected learning opportunities - the type that couldn't be acquired from reading a book or taking a class.

On to Another Kingdom

My four-year experience as a nurse in the Kingdom of Saudi Arabia gave me a unique opportunity to learn, in one setting, about a variety of cultures. Over time, I discovered that many of my preconceived ideas were dispelled, while others proved true. Occasionally, the challenges posed by the differences made me want to escape to the familiarity of my home in the United States. But I persevered, and was inspired to continue my adventures abroad.

I have now taken what I learned to another kingdom - the United Kingdom - where I currently work. My one of a kind experience in Saudi Arabia couldn't have been a better starting point for my journey.

(Published with permission of MedHunters.com.)

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