What it Means to be a Nurse in Different Cultures

Crawford in the Republic of Georgia where she teaches students from a variety of backgrounds who come for training

Kim Crawford has put her nursing skills to use in her home state of Georgia, as well as overseas. She explains what nurses need to know and how they are valued at home and abroad.

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Tell a little about yourself including what drew you to nursing as a profession. 

I grew up in Atlanta, Georgia next to the Center for Disease Control and Emory University. My father was a dental professor at Emory and he taught me when I was a young teenager about how the heart worked. After that I was hooked. I wanted to do something in the healthcare field. I looked at other healthcare professions including medicine and veterinary science, but wanted something, that when I graduated I could work and, that didn’t require any more school. At the time, I was a good student but did not enjoy school. I much preferred other things like sports or playing my cello to opening a book.

I grew up in a house that always had other people over, whether friends from church or classmates. My mother volunteered a lot at our school and had been known to teach fellow classmates how to drive, or she would get supplies for their class projects since their families were usually single parent households. My parents had also traveled several times to Latin America to provide dental care in villages. We learned early on that we were to share our lives and our gifts with people around us regardless of whom they were or where they came from. Seeing people as people and equals regardless of where they are in the world set my path to nursing long before I had even thought of it.

I was a pediatric emergency room nurse for 12 years and did many short-term trips to various countries for teaching as well as providing disaster response. Somehow I ended up here in Tbilisi about five years ago doing continuing education for nurses, many of whom had never had it. This led to my current job as a professor of nursing and public health at a private university in Tbilisi, Georgia.

 
What is your greatest emphasis when you are teaching nursing students from other cultures? Are there things that you have to focus on that are different from teaching U.S. nursing students? 

Since I teach in the country of Georgia and not the State of Georgia, there are many, many differences. The textbooks that we use are from the U.S. or U.K. and some of the content is not relevant to my Nigerian students. There is a lot of explaining regarding some of the anecdotes or cultural assumptions that are written in the literature to make relevant to my students and to the Georgian Healthcare System. Different aspects such as electronic charting, certain insurance schematic types, and even types of equipment used from intravenous pumps to bandages have to be explained knowing that they may not be working in that environment. I take the approach that I will teach them from a western perspective as well as from a current resources available basis. It teaches them to be flexible and possibility be innovators in the community in which they will work.

In addition there is an emphasis on respecting other cultures that often times they are not taught to the level Americans are taught in school. Providing cultural care that involves learning and respecting the differences in all people one comes in contact with. Most students, both Georgian and Nigerian, have limited skills in this area due to living in homogenous environments and have had limited exposure to other cultures.

 
What are the biggest cultural differences you've encountered when it comes to what is expected of nurses including training and demeanor? 

In the country of Georgia, nurses are almost at the level of the maintenance staff. They are not considered a respectable or valued profession as they are in other countries. Up until a few years ago, nurses were not even considered to have a professional level of education. To come from a culture where nurses are more trusted than physicians, developing and implementing a baccalaureate nursing program has made for a very daunting task. Promoting nursing as a profession has become one of my most important tasks.

We are in our final semester of our first cohort of students and each semester has brought along unforeseen challenges from making sure that we have documentation for the students to showing up to clinical lessons and class on time, to the skills of being able to write a term paper. This is in addition to just working through a regular nursing curriculum.  

Developing a level of accountability, objectiveness and even attempting to improve quality has been the most exhausting process. Throw in the different dimensions of superiority and respect based on age or job title or even just saying what is expected to be said rather than the reality and it is a very different ballgame than the US.

 
How has nursing changed over the years in the U.S. and in the places you've been, if at all? 

Nursing in the States has become much more autonomous and patient-centered while promoting a climate of safety and prevention. This is to the point where we don’t realize that we are doing this until we move to another culture and realize that these basic principles don’t exist. Nurses have so much autonomy and are able to truly empower the people they come in contact with. In Georgia, I have seen nursing go from no one even knows what to call them (really!) to seeing nurses grow in their solidarity and hear people say that they need better trained nurses.

So at least nursing is on the radar of hospital administrators and policy makers though a small blip. The nurses that I have trained in continuing education in Georgia, I have seen a change in their demeanor. They are more encouraged and empowered than five years ago. 

Are there a couple of situations through practicing nursing or teaching that have really stuck with you, either good or bad that you could talk about? 

I didn’t know how much I loved my profession until I started teaching it in other countries. I always loved my job as a Pediatric Emergency Room Nurse. There was always an adventure just around the corner. But when I went into worlds unknown whether it was for disaster response or coming to Georgia and teaching those who had been nurses for 20 years but had never had a continuing education course, my love grew. A couple of situations still come to mind.

While in Sri Lanka, after the Tsunami that hit in 2004, I was working in a refugee camp in a makeshift clinic made up of a few tents and other volunteers like me who were there for a few weeks to just fill in with basic medical care since all of the local clinics and hospitals were either destroyed or overwhelmed by this tragedy. We had had busy days of seeing patients and had eaten dinner, played a little soccer with the local children and were about to head to our sleeping bags and camping mats when we heard a cry from some locals. They were bringing in a man who had been in a motorcycle accident. I cannot remember if he had been hit with a motorcycle or had been the one driving it when he was injured.

In addition, he had the smell of alcohol on his breath. Most of us were Americans in this clinic and we all knew what the other was thinking, “This man is a drunk.” One of the physicians was an emergency room doctor. We both knew what to do and worked as though we had worked together for years. That is the exciting part of having such a well-trained system in the US; it builds for well-trained teams when put together outside of the US.

This man had burns on his legs and hands and abrasions and lacerations on his head and arms. We worked on him by flashlight for two or three hours. We didn’t need to give much pain medication since the alcohol’s sedative effects had kicked in; though we did wish we had breath mints for the patient. We found out later that this man had lost his entire immediate family in the tsunami. He was grieving the best way he knew how and probably had a death wish as well. There were no lights except by the moon that was covered by clouds and he was heading to a friend’s place for the evening. We were able to clean his wounds, give him a place to sleep for the night and provide antibiotics; all things that had we not been there, at the very least, he would have lost a limb or two.

 Another instance that comes to mind is of a student of mine here in Georgia. This student walked in the first day of simulation laboratory late and did not seem to have a clue and I thought: there is no way this guy is going to make it. But slowly, he changed, matured, grew not only as a nurse but as a person. This past summer he volunteered at a children’s hospital all summer. He is also starting an international nursing club here in Georgia. He is always the first to volunteer for any medial task that the dean needs help with. He has grown into a man of convictions and service. He doesn’t seem to have the social fears that one would have when moving to a new country. His grades continue to be average, but being able to witness the transformation of a boy becoming a man has far surpassed the importance of any grade.

I feel honored that I have been able to be a part of this transformation. I love to teach and I love nursing. It is one of the few places I don’t have to be judgmental. I just have to care and be consistent. I can grieve with those who are grieving, provide a bit of relief even if only temporary to those who are hurting. I can teach and model what a western nurse looks like without all the fancy uniforms, gadgets and even paychecks. I can practice and teach what I love.

Where would you like nursing as a profession to be in 10 years. What about you in 10 years? 

I hope nursing continues to grow as a profession here in Georgia, where nurses become a profession with autonomy, critical thinking skills and patient educators. In the west, I hope that nursing turns not only to those patients in the U.S. but that there is a bigger focus building up the nursing profession in other countries. Nurses empowering nurses, all from different cultures and backgrounds. In the U.S., we are too caught up on benefits and paychecks that we miss the much bigger blessing of reaching out to others who don’t have the same benefits and paychecks we do.

The real reward and blessing lies in investing our time, skills and energy in those who do not have those resources. Initially we think that we will be able to make a big difference, but in the end it is we who are changed. I am not sure what would happen in the U.S. if or when I return to teach. I am not the same person as I was five years ago. I am starting my PhD to continue my education so that I can learn how to better educate others. I hope in 10 years I am in a university that values education over money, looks at the nursing profession as one of the greatest potential life changers of the 21st century for the developing world, and that my passport is always close at hand.

Interview By Suzette McLoone Lohmeyer