Heather Konstanzer, junior
As you’ve probably learned in your Freshman Seminar, Contemporary or Fundamentals nursing courses, NCLEX loves to ask about cultural considerations. Sure, studying from books can teach you which ethnicities eat what, the days that certain religions observe holidays, etc. What these books don’t teach is how you, however, is how you, as a nurse, will react when you’re taken out of your comfort zone and you’re implanted into a society bearing social, cultural and professional norms that differ from your own.
This Summer, I traveled to Cuenca, Spain—a small city located Southeast of Madrid. There, I spent three weeks shadowing healthcare professionals of various specialties, teaching English to Doctors and gaining invaluable experience in practicing cultural competence. During these three weeks, I embraced the Spanish culture and was exposed to their version of healthcare. Despite the common goal of delivering quality care to patients, I noticed several significant differences between care in Cuenca, versus care in the United States. While perhaps had I interned in a larger city, I would have drawn more parallels between the two systems of care, I felt that in Cuenca, the patients generally acted less sick, the hospital setting was much more casual and deliverance of care was far less complicated.
Part of the Spanish culture is to be very direct. While, warned of this by one of my fellow Atlantis Project peers, the doctors I worked with never sugar coated anything, did not worry about political correctness and were surprisingly blunt in their manner of speech. This aspect was, in many ways, extremely refreshing. If the doctor I was working with was doing paperwork and I was uninterested, they took no offense in my stating, “I’m bored and would like to go work in the Emergency Department for the rest of the day.” In the States, I probably would have panned my way around saying that I was uninterested. I now try to adopt this habitude in my daily practice. While there is more backlash associated with saying what you feel in our culture, it is truly empowering and much more efficient to be assertive with what you want.
As part of my rotations, I was able to see intensive and emergent care. These patients were critically ill, however in some way they seemed less debilitated than American patients. My completely subjective analysis of the patients was that they simply seemed to take less pity on themselves than the typical American patient. For example, a patient could come in with a broken ankle, directly state what facilitated the broken ankle and then listen to and abide by what the doctor said. In my experience in the States, the patients, more often than not, have circuitous stories about what happened to them and then proceed to question the doctor about his or her choice of treatment, how their insurance will factor into the care and how abiding to treatment will impact their normal routine. Not once in Spain did I hear the phrase, “WebMD says. . .” The submissiveness to the doctor makes care appear more concise. In the States, it’s our drive to be knowledgeable consumers and participate in our care that sometimes interferes with expediting and simplifying care.
Another compounding factor in the United State’s complex healthcare system is our idea of a market-based system in which private companies dictate cost and provisions of medical coverage. Each year, the US shells out more money per capita than any other nation in the world, and yet we rank near the bottom of all developed nations in terms of quality of care. The act of controlling costs not only burdens these companies, but it burdens the consumers. Constantly worrying about what is covered versus not covered impedes quality and equitable access to care. Along with individuals not having insurance, some Americans will actually experience adverse outcomes due to delay in seeking care, simply because it’s not covered. Spain’s healthcare system is government funded, which takes out the middleman of private markets. Costs come from one party—the government and access to care is relatively standard across the population. The idea is that everyone pays into the system and everyone benefits.
From my experience abroad, I’ve gained confidence in my practice and abilities. I am better equipped to empathize with patients of foreign cultures, because I’ve experienced what it’s like to be an outsider in another country’s healthcare system. After witnessing the lack of autonomy nurses in Spain appeared to have, I have an immense appreciation for the latitude that continuing education provides for nurses in the United States. Most importantly, I discovered that truly exceptional care is up to the individual practitioner, not the system itself. Each healthcare provider has the responsibility to improve the circumstance of each patient they encounter, and to the best of their ability, strengthen quality of care.
Photos by Heather Konstanzer