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Vital Signs

By Violet L. Hayes, RN

Vital Signs author Violet L. Hayes

Appreciating Patient Diversity

T wenty-eight years ago, when I began my nursing career at Isabella Geriatric Center located in Manhattan’s Washington Heights area, the patients were different from the ones I care for today. The institution’s population reflected that of the surrounding area, which was predominantly Jewish. Over the years, however, immigrants from the Dominican Republic have made this area their home, which in turn has changed the demographics of the nursing home, inspiring our 670-bed facility to implement changes that make our patients feel more comfortable.

For example, the things that I was used to seeing at Isabella Geriatric Center years ago—like cheese blintzes, borscht, and knockwurst—have now been replaced by red beans, plantains, and arroz con pollo. Where Hebrew was once spoken, Spanish now resonates.

As the community where I work has changed ethnically, I’ve become acquainted with cultural practices that were once unfamiliar to me, and I’ve seen how they influence a patient’s care. I credit Jorge Sanchez and his family for teaching me a valuable lesson in diversity.

Mr. Sanchez, a 79-year-old Dominican father of 22 children, fell into a coma after cardiac surgery and was admitted to the center with a tracheotomy and gastrostomy in 1994. Mr. Sanchez’s respiratory status required aspiration precaution and close monitoring because of the complications associated with gastrostomy tube feedings, and he needed incontinence care to maintain skin integrity.

They refused to
let their father’s
illness inhibit
their family
gatherings.

The Sanchez family refused to let their father’s illness inhibit their familial practices, which included routine gatherings. In the past, the families of patients at the center only came during visiting hours. But the Sanchez family insisted on participating in their father’s care, which kept them at the center long beyond normal visiting hours. For example, not a day went by that a family member was not present, visiting for up to 12 hours at a time. It seemed an obligatory yet natural part of their family life. His eldest son, Javier, would often bring a specially prepared solution, vigorously rub it over his father’s body, and chant in an effort to awaken Mr. Sanchez from his coma. The family would perform range of motion exercises and bathe and dress him, even after the nurse’s aide had already done this.

Javier would take his father home once a month and on holidays to visit for a few hours with his children and grandchildren. This meant pushing Mr. Sanchez in a geriatric chair for three city blocks. Javier felt that having his father around active people who loved him would bring him back, since Mr. Sanchez had always been a very active man, having worked for years in construction in Santo Domingo.

In spite of our strict visiting policies at Isabella Geriatric Center, I saw no problem with bending the rules a little not only for the comfort but also the welfare of Mr. Sanchez. The doctor, who was also Dominican, agreed. I worked with the family to help plan Mr. Sanchez’s discharge, which included teaching the family gastrostomy and tracheotomy care. They were grateful that I understood their needs.

In all my years of nursing, I have never seen such family devotion. Within a year, Mr. Sanchez was discharged, and he returned to the Dominican Republic where he lived with his wife and children, still comatose until his death in 1996.

All patients and families have their own values regarding illness, life, and death. By respecting the patient’s cultural beliefs, we can help ensure that he receives care that makes him and his caregivers more comfortable.

Violet L. Hayes, a member of the New York State Nurses Association, is head nurse for a 45-bed unit at Isabella Geriatric Center, New York, NY.