MPCC nursing students Chelsie Markley, Candice Myers, Treu Gibson, Taylor Cooper and Brooke Rubenthaler assess a patient in the college's simulation lab in April. It was all part of a staged medical situation to teach the students about cultural diversity.
It's not enough just to treat patients - the key is to give them the kind of care they've come to expect.
At Mid-Plains Community College, the ability to recognize and accommodate the needs of people from various races and religions is a main component of the nursing curriculum.
"We start emphasizing cultural sensitivity with our first-year students," said Marina Makovicka, a nurse educator and chair of the Health Occupations division at MPCC. "The issue is huge right now, and we dedicate about 20 percent of our studies to it."
MPCC's nursing instructors have been teaching cultural awareness for about five years – ever since the department moved into a new Health and Science Center. However, the extent to which the subject is covered has increased just since last fall.
"That's when we implemented a new curriculum," said Makovicka. "In the old curriculum, we only had one semester that addressed the sensitivity of different cultures. Now, it's something that is taught throughout the duration of the program."
Although North Platte's population is not as diverse as other areas of the country, or even the state, Makovicka said local health care professionals are seeing an increase in certain groups. Those include Hispanic/Latino, African American, Asian, Native American, Indian, Guatemalan and Somali.
According to the Pew Research Center, the U.S. admitted 84,995 refugees in 2016 - the most since 1999. Nebraska, North Dakota and Idaho ranked near the top for the most refugees resettled per capita, with rates over two-and-a-half times the national average. Of those, 46 percent were Muslim.
"It's important for our students to know who they could be treating," said Makovicka. "There's nothing more embarrassing for a nurse than to not have a clue about what a patient wants or needs. From the patient's standpoint, it's bad enough to be sick or wounded, but to not have anyone understand you – that's isolating."
MPCC's nursing students begin learning about ethnic variations during classroom lectures. The instruction gradually becomes more in-depth, eventually transitioning over to a simulation lab.
There, students are placed in a mock hospital room with a patient simulator. They receive a report that includes the patient's name, age, religion and culture and are asked to respond appropriately to a staged medical situation.
Makovicka uses a computer outside the staging area to control the simulator's requests and actions. She speaks for the simulator through an intercom and monitors the students' reactions through a two-way mirror.
"I may put a wig on the simulator to make its appearance representative of particular race," said Makovicka. "I also usually have one of the students dress up to role play as the patient's family member."
She might place foreign books, food and decorations around the room to heighten the effect. If a child simulator is being used, Makovicka will often lay a stuffed animal beside it and, give the toy a name commonly used by the culture she's trying to replicate.
For first-year nursing student Donette Horn, of Ogallala, gaining a sense of the diversity that's around her has been eye-opening.
"I didn't know that I could encounter so many different types of cultures in a rural Nebraska workplace," said Horn. "I'm glad I'm learning about them now as opposed to on the job. That way I can feel confident and prepared for any situation."
While MPCC's nursing students aren't required to speak a foreign language, although that can be helpful, they are expected to know when to call a translator.
"In the past, that used to be an in-person translator," said Makovicka. "Now, on-demand translating services are available. Nurses simply have to look up a number from a list of languages and dial it to create a conference call with themselves, the patient and an over-the-phone translator."
MPCC's cultural instruction doesn't stop at language barriers, however. From there, the nursing students delve into customs, rituals and nonverbal communication.
"For example, many Asians don't like eye contact," said Makovicka. "To them, it's disrespectful, whereas to Americans, not making eye contact is disrespectful."
Some religions, such as Jehovah's Witnesses, don't accept blood transfusions.
There are also major variations in the way people enter and leave the world.
"Differing cultures have certain ways they like to have babies delivered," said Makovicka. "Sometimes only specific things are allowed to touch the babies or mothers. In the Somali culture, everything has to be all white – the blankets, the sheets, etc. Anything other than white is not allowed near the baby."
She said no one but the physician and father are allowed in the room during a Somali delivery. However, there is an understanding that if nurses need to intervene from a safety standpoint, they can.
"Another thing that takes some getting used to is that the moms don't talk during a delivery – the husbands talk for them," said Makovicka. "Once the baby is born, anything used to wipe the child off must be touched by the mom first."
Somalis have specific death rituals as well – one of those being that they take their loved ones home instead of to a funeral home.
"Native Americans burn sage after a death," said Makovicka. "Hospitals allow it, and we need to be respectful of it. As nurses, we have to put aside any beliefs we may have that are contrary to the customs of others. Only then can we give stellar culturally-oriented patient care."