I worked as a nurse in a hospital all afternoon. It was a warm day with a visiting families event taking place. I was taking care of an African patient who had a child that was running in the hall, this seemed to annoy the health team.
I knocked on the door of the patient to install a perfusion. The family was present and I asked them to please step out for a few minutes. After some hesitations, they did. I felt something under my shoes, there was coarse salt covering the entire floor.
The patient saw the surprise on my face; she did not speak French very well and tried to explain that it was to drive bad spirits away. I installed the perfusion thinking about how to clean up the floor because we have strict rules to adhere to in the hospital regarding hygiene.
I did not really feel a cultural shock because I knew the tradition and beliefs because of my cultural origin. But it was the first time that I saw it in the hospital so my professional identity has been compromised.
I ended the consultation and said goodbye to the patient when suddenly an auxiliary caregiver came into the room without knocking. She is an experienced worker, (been there for the past 10 years), she was about 50 years old and was also in charge of the room cleaning.
She discovered the coarse salt on the floor and shouted: “What is this mess? It’s disgusting.” I felt very uncomfortable and ashamed, the patient did not understand this aggression. The situation turned into chaos, however, I tried to calm it down by saying that we will find a solution.
1. Identities of the actors in the situation
The narrator is a young nurse and in her first year of nursing. She is 23 years old, works in a general public hospital. The nurse comes from a Muslim family but is not a practicing Muslim. She describes herself as lay / secular (“laique”) in her personal and professional life
The patient, about 40 years old from a sub-Saharan African country, did not speak French.
The relatives, 10 family members also from the same African country, none of them spoke French.
The caregiver (auxiliary), is a woman about 50 years old, has been working in the hospital for 10 years. Comes from a very small village in France.
The relationship between the narrator and the caregiver:
They knew each other and worked together several times before. Their relationship was only professional and the narrator says they did not share the same professional culture. The caregiver seemed to be old fashioned and was not very nice to the patients and their relatives in general. The narrator describes her as narrow-minded and a little bit too strict.
2. Context of the situation
The incident happened in a general public hospital room in Lyon (City in France), the patient was lying down on the bed, hospitalised and expected to receive treatment for a few weeks.
3. Emotional reaction
Her emotional reaction did not come from the fact that the room was full of salt, but from the reaction of the caregiver. She said she was a little surprised about the salt but she quickly understood that it was a ritual. Due to her own origin, she knew that the salt was a means of protection in several cultures.
The first emotion was embarrassment of the behavior and the attitude of the caregiver, as she judged the situation to be very unprofessional.
She felt anger because of the reaction of the caregiver who was aggressive with her words and mean with her tone. Finally, she felt sorry for the patient that was mistreated. The patient was ill and she did not understand French neither did she understand what the caregiver was screaming about.
The narrator also felt responsible in this situation as she felt the need to protect the patient from this aggression and tried to explain to her what was happening. The patient looked at her for help, empathy or protection.
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
Respect for patients: For the narrator this is an important value when it comes down to people, especially if they are in a vulnerable situation (as the patient). Health professionals should be caring towards the patient and at no point aggressive, either physically or verbally. To show respect in this case means not to upset the patient, not to shout or scream at someone that it is trying by every possible way to get better.
Professional Identity threat: The narrator expresses that the wellbeing during treatment is not only the consequence of “drugs” but of the whole environment, therefore the staff of the hospital is part of the care that the patient needs. That is why the nurse’s professional identity was threatened by an older and more experienced colleague, who did not respect the basic rules of caregivers putting the needs of the patient as a priority.
Fear of intolerance for foreigners: The narrator thought that it is important to be empathic with the patients, however, she expressed that she was particularly shocked by this incident as she identifies herself as a “foreigner” with a foreign background and that one day she might be the one being misunderstood by someone else. As she originate from Maghreb she could easily relate to the situation of the patient, this can also be seen as a fear of intolerance and cultural rejection.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
Referring to the caregiver:
Asepsis and Hygiene: For the caregiver that has been working for 10 years in this hospital the norms of hygiene is something non negotiable. In the hospital, the rooms must be clean in order to keep the best environment for the healing process of the patient.
Professional Identity Threat: The caregiver thinks that her “job description” does not include cleaning unnecessary chaos caused by the relative of the patient. This adds an extra task for her.
Healing Treatment: The caregiver does not believe in “ritual” healing processes as the medical one is the only one existing in her cultural frame.
Referring to the patient’s family:
Representation of illness and healing: illness is not only the consequence of bacteria, virus and other scientifically identifiable causes, but also a consequence of more spiritual factors. Therefore, in the healing process, these transcendental factors have to be catered for, possibly via specific cleansing rituals.
Salt: Common salt, sea salt or kosher salt – all has a long history of use in rituals of purification, magical protection and blessing. Salt rituals have been practiced in various cultures for thousands of years, and continue operating until today. The salt can be use as a protection and as a purifier: it cleans the bad energy and protects you of noxious energies.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
The incident highlights the experiences of “culture shock” where the source of the shock is not so much due to a national / ethnic difference, but a difference in professional culture that is displayed by a co-worker. As our narrator puts it:
“This incident made me think about how we treat or how we deal with the manifestations of diversity in the health care system in France. It made me wonder about the fragility of some of the patients who face abuse from some Health care staff. I also think that diversity in general is not recognised in the public health system and this is a shame as we could prepare ourselves better.”
The incident also points to the contrast between different rationalities: the scientific – materialistic rationality of the hospital, based on explicit rules and regulations, and the magical-religious rationality. Even in situations where the rites do not threaten regulations, nurses representing the “scientific rationality” and order of the hospital can have strong negative reactions to the “irrational” practices, as if they were a symbolic threat to the trust patients have for them.