by NOEL CHRISMAN, PH.D.

I was invited to do a presentation on cultural competence to the hospice staff and a large, successful, and very white hospital. As part of my preparation, I visited the in patient hospice one afternoon. At the end of my visit I sat with the nurses as they debriefed the shift. One, a leader of some sort, said that she was pleased I would talk to them since she felt that she needed to know more. She then said why. She had been rushing around for the last few hours to solve a problem for a Vietnamese man whose wife had just died in the CCU following palliative surgery for cancer. The CCU needed the bed, but the husband told the nurse that he needed to be with his wife for three days in case her spirit returned. At about this point I wondered out loud what the problem was since the nurse seemed to be listening in a neutral fashion-an important early step in culturally competent care. She went on.

She looked through the hospital for a room where the man could be in private with his wife. In addition, she negotiated with some service that needed to have the body for standard hospital procedures after a death. Ultimately, she succeeded in getting the service to back off. In addition, she found that the hospice conference room might work for the sitting process. However, there was a conference in there; she threw them out.

At this point I was astounded that the nurse felt that she needed more education/practice in cultural competence. She had exhibited the kind of system savvy that I think is essential in cultural competence and engaged in a negotiation process that is the essence of cultural practice. What, I wondered, was the problem? I asked again. She said simply: "But the husband does not believe that his wife is dead."

I think that despite her culturally competent approach to the situation (i.e., moving the patient and her husband to the conference room), the nurse's western biomedical world view prevented her from adequately "hearing" what the husband was saying. Her beliefs could not accomodate the possibility that the spirit of the deceased could come back and consult with the living -- a belief found in Southeast Asia.