Growing up in Africa, I had no concept of the Western approach to mental illness. Rather than treating the mentally ill as sick people, many Africans believe that mental illness is a manifestation of something else, traditionally a curse. Therefore, the steps taken to help the person are not helpful, and, in many cases, can actually compound the underlying mental health condition. Coming to the United States, one of the most significant cultural learning experiences I had was discovering that being "crazy" is not the result of a curse, but that mental illness consists of a constellation of diseases, many of them with successful treatments, if no cures. I have remained fascinated with mental health issues and the notion that, with treatment, people suffering from mental illnesses can live happy and successful lives. This knowledge led me to become a nurse practitioner focusing on psychiatry, where I currently work as part of a mobile crisis unit attached to a psychiatric emergency room.
I cannot think about my own background without thinking about cultural competence and ethical values. In my experience, I have seen that many Western-trained medical personnel have no idea that Africans still largely believe in the idea that mental illness has a supernatural cause. This is a critical factor, because it can prevent families from seeking any type of help for afflicted family members and help establish a cycle of blame in the family that is corrosive to the patient and the patient's loved ones. To me, the idea of cultural competence is that a practitioner knows enough about a culture to know when they need help from an expert in that culture. For example, I have had limited experience with members of some different cultural groups. That experience, and what I have been taught about different cultures, provides me with enough basic knowledge to provide emergency support services. Furthermore, the nature of emergency services means that cultural issues are not the top priority; safety is. However, this changes in a long-term treatment setting; whether a disease is physical, mental, or a combination of the two, family dynamics and cultural concerns become relevant when establishing a treatment plan.
My background also makes me consider the idea of medical ethics, specifically when it is appropriate to treat a patient who is not seeking, and, in fact, may be refusing treatment. Working with a mobile response unit that responds to psychiatric emergencies, I am generally not interacting with people who are seeking help for themselves. Instead, the calls are usually initiated by friends, family members, or even strangers who notice a behavior pattern that is reflective of disturbed mental functioning. Working in this area, it is always difficult to balance the ethical norms of respecting a patient's autonomy and right to self-direction, while also preventing the patient from remaining a danger to self or others. Furthermore, ethics dictates confidentiality, but with a mentally ill population, treatment can be almost impossible without communication from others in the patient's life. As a result, I am always considering ethical values in my work, trying to mindful of what the rules dictate I must do, while also heeding what my conscience tells me I should do.
My entire background in psychiatry, psychology, and mental illness creates a constellation of personal qualities and attributes that will be useful to me as I pursue my Doctor of Nursing Practice degree. I say this because that experience helped highlight to me that what is currently known about medicine is not all that there is to know. Growing up, I was taught that clearly identifiable medical issues were the result of something supernatural. Furthermore, because of how those issues present, a supernatural explanation made sense. However, I learned that medicine could treat those problems and that there was help available for the people. Today, there are many patients who present with signs and symptoms outside of a defined, known disease. Many established doctors and nurses have dismissed these illnesses as imaginary diseases or signs of mental illness, until the illnesses have gained broad acceptance in the medical community. I feel as if my personal experience will make me more receptive, not only to complaints by patients, but also to emerging research. It was within my own lifetime that a broadly recognized disease, fibromyalgia, was dismissed as a by-product of depression. I feel that my personal background leads me to be more open to medical advances and less rigid in my approach to individuals than many of my peers.
However, my openness can also be a detriment as I pursue my DRNP. There is no doubt that there is a very broad body of medical knowledge that must be learned, and while, not exactly unassailable, has certainly been well-established. It is only by working from the basis of what is known in medicine that the science tends to make significant advances. I will need to work on my foundational knowledge. Furthermore, I will need to work on my analytical and logical reasoning skills to help independently interpret some of the conclusions that result from the established science. I see no merit in simply accepting what others have discovered as truth, if I am unable to understand how they came to that conclusion.
For example, my nephew has autism. He was young enough at diagnosis that there was still a substantial reason to believe that autism might be linked to vaccinations. It was an idea that my family discussed, and we did not oppose delaying vaccinations for children in case there was a link between vaccinations and autism. Of course, it was later revealed that the scientist who established that link fudged his numbers in order to support his desired research result. I feel like having had better logical and analytical reasoning skills, at that time, would have better prepared me to question that link between childhood vaccines and autism, and engage in a better cost-benefit analysis of the practice.
At this point in my life, my goal is to become the head of my department's emergency mobile response unit. This position can be held by either an MD or a DRNP, and I seriously considered the merits of pursuing an MD instead of pursuing a DRNP. For many people, an MD is a more respected position and it is more likely to result in a higher salary. However, having spent so much time in practice, including practice in medicine and surgery, I came to the conclusion that becoming an MD would strip me of the part of medicine that I most love: meaningful interaction with patients. Time and time again, I have seen doctors rushing from patient to patient, unable to establish a meaningful personal relationship, and, in many cases, viewing those patients as constellations of symptoms, rather than human beings. I do not ever want to lose sight of the fact that every patient I have is a human being. As a result, I want to continue down the nursing pathway, and use the DRNP as a means of attaining my professional goals, because nursing focuses on the patient, first.
That nursing is my calling reflects what may be my most powerful leadership skill: empathy. People do not discuss empathy as part of the leadership skill toolbox, and I believe this is a very negative omission. In many instances, people who are empathetic are viewed as weak, but that is not the case. Empathy simply means that I am able to put myself in someone else's shoes for a few moments. To me, the fact that I am willing to listen to people and make an effort to try to understand their perspective has provided me with leadership opportunities, because people know that I am genuinely trying to work towards their goals, not simply forwarding my own…