The start of my junior year medical-surgical rotation began the same way it usually does for many other nursing students--with a feeling of nervousness due to the uncertainty of how my first day on the clinical unit would evolve. Upon receiving my patient assignment, I realized my day would be unlike that of my classmates, because my patient could only speak Spanish. My clinical instructor had made the assignment based on my Hispanic background and my fluency in Spanish.
I received the nursing report, which was limited to the physical assessment because of the nursing staff’s inability to communicate with this gentleman. No admission information, health history or personal information about the patient had been obtained, because he had been dropped off at the Emergency Department with no one to help interpret for him. The admitting diagnosis was kidney failure with a secondary diagnosis of cirrhosis. Laboratory values and diagnostic tests were conclusive with the diagnoses.
When I entered my patient’s room, I immediately noticed the fear and pain in his eyes. He was grimacing and teary-eyed, which broke my heart. I was sure the language barrier must have created feelings of loneliness and fear. When he heard my Spanish greeting, his whole appearance changed. He smiled and asked me if I spoke the language, and I answered “yes.” He said, “Hay, gracias,” which means thank you, with a sigh of relief.
The patient was able to talk to me about his abdominal pain and his arrival at the ED. He explained that his boss, who did not speak Spanish, had brought him to the hospital and immediately left. When I asked if there were any friends or family members who could assist him with his communication needs during his hospitalization, he replied “no.” He told me that he lived with a group of other migrant workers and that they were unable to leave work.
I realized at this point that he was completely alone, with no one to help him with his medical, legal and emotional needs. In the back of my mind I knew that meeting the needs of this patient was going to be a significant challenge for me, a student nurse. But I was keenly aware of the impact my nursing interventions could make. I put my nerves aside, gained my confidence and told myself that I was there to help this patient receive the medical care he deserved.
Communication and Comfort
I proceeded with my nursing assessment, gathering and writing down as much information as possible. I provided the patient with information about the daily routine of the hospital, such as what to do when he had pain, how to use the call button and when meals were served.
I asked if he knew why he was in the hospital. He didn’t exactly know what was wrong with him. He acknowledged that he was in pain and said he needed pain relief so he could go back to work. He complained of generalized right quadrant pain and stated that this was not the first time he had experienced this type of pain. My physical assessment revealed a distended abdomen that was tender to palpation.
After I gathered my assessment and provided comfort to my patient, I returned to the nursing station to talk with his primary nurse. We discussed his medical and personal situation. It was necessary for this man to understand his medical condition and his need for urgent treatment. It was also necessary for the hospital to obtain legal documents such as a living will, power of attorney and a phone number for notifying his next of kin.
I returned to the patient’s room and explained to him that he was very ill and would not be going back to work anytime soon. I educated him about his disease. I asked him if he drank alcohol and he replied that he did drink every day but not in large quantities. I explained that his kidneys were failing, his liver was seriously diseased and that it was necessary for him to avoid drinking alcohol.
I could see the fear in his eyes, and his skin color changed. His closed his eyes and began to cry. I tried to comfort him. He continued to cry, asking how this could have happened to him and what was he going to do, because he couldn’t lose his job. He spoke about his family who lived in Mexico and how he wished he could see them. He said he came to America for a better job and sent the money he earned to his family, but was never able to contact them. He sent letters to his wife and daughters but never knew if they received them. He confided that it had been 10 years since he had seen or spoken to his family. He started crying with such intensity that it broke my heart, and I cried with him. I remember holding his hand, feeling helpless as he sobbed that he wanted to see his family.
At the end of the day, I finished by reviewing the information he needed to know about his hospitalization and medications. I told him how important it was for him to stop drinking alcohol and to take all medications prescribed to him.
When I entered his room one last time to say good-bye, he told me how grateful he was that I had been his student nurse. He said, “I felt relieved and less scared knowing that you were able to understand me and explain everything to me.” At that moment I truly realized my potential as a student nurse to make a difference in a person’s life. I remember telling him before I left to “stay positive and take care of yourself as much as possible.”
As I left the clinical unit I felt a sense of satisfaction and honor to have been able to take care of this patient. I came to the realization that I was able to provide this man with some comfort and put a smile on his face during a dark time in his life. By intervening on behalf of this non-English-speaking patient, I had made a difference for him, for the staff nurses and for myself. As a result of this experience, I feel more committed to fulfilling the needs of my patients, and particularly those patients who face barriers to care.