Cultural Challenges in Nursing

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It was not merely the ubiquitous presence of death which transfixed but the manner in which death was observed, or denied, as the case may have been. On the oncology unit I first encountered the pervasive silence which surrounds, engulfs and renders nursing complicit. What needed to be stated between physician and dying patient remained largely unsaid. Too often patients were left to discern their fate through a solitary process of elimination. At this stage a keen sense of betrayal gave rise to anger which, for many encompassed the nurses as well. As caregivers we nurses enabled the charade its continuance, administering ultimately futile treatments and emptying emesis basins long after the oncologists ceased making their rounds. My brief time on the unit stunned me, and I became, if not mute, less certain of the efficacy of my own voice. The complex ethical conflict which arose from the silent complicity of the oncology ward ended when my father’s death on the unit which I practiced propelled me from the hospital into community health nursing. (Gorman, 2001)
The above observation, similar to my own experience, leaves the writer in a state of dissolution that drives for both personal and professional change. When I began my nursing career I decided on a prison unit at a large teaching hospital because of the wide variety of conditions that were treated there. If a person was ill, not critical care or OB eligible and a state inmate, they most usually landed on my unit at

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