Barbara McLean, MN, RN, CCRN, CCNS-NP, FCCM, a renowned nurse intensivist and critical care specialist, was invited to speak at the first Scientific Nursing Symposium in the eastern province of Saudi Arabia in May 2006.

She was thrilled. “I was fairly surprised to be invited to speak at a nursing conference in a country that has not been known for female rights and where nursing is considered a primarily female profession,” said McLean. “I had been referred to the organizers (along with others) after they had contacted AACN, and they reviewed both my Web site and my curriculum vitae prior to choosing me.”

McLean’s journey to Saudi Arabia took about 20 hours, with flight time from Atlanta and a seven-hour time change. She arrived in Dammam, a modern city about midway in the crescent of the gulf of Saudi Arabia, more Westernized and less conformist than some other areas of the country.

“Obviously, when you go anyplace where you don’t know anyone, there’s always some uncertainty,” said McLean, “I had read a little about Saudi Arabia and Muslim practice, and was aware that, out of respect, I should cover my head. Upon arrival, I was repeatedly told that it was not imperative, but I felt I had the opportunity to connect with another culture in a person-to-person way, not government-to-government, politics-to-politics, or money-to-money. We all have the same interests—we want to do what’s right for patients. And indeed, that was true.” When she arrived in Saudi Arabia, were nurses (all female) and female physicians who were completely covered (wearing both head and face covering) to partially cloaked (head and body, but not face) (see photos). More important, she found that, similar to the United States, everyone desired change in healthcare practice and communication.

“In the Saud Al-Babtain Cardiac Center the intensivist director expressed the desire to have nurses be more assertive and vigilant,” said McLean. “The physicians and the nurse director want nurses to be able to communicate to the physicians when they feel the right things are not being done for patients. We, of course, have that same issue here in America, where nurses may feel insecure in their communications with physicians but are always concerned with advocating for the best interests of patients. It’s amazing how similar things are all around the world. In addition, historically, men in Arabic countries have not been encouraged to go to nursing school and women have been (somewhat) liberated in the United States for the last 35 to 40 years.”

The Saud Al-Babtain Cardiac Center, an extremely high-tech facility associated with the Dammam Central Hospital, and the location for the conference, is a free-standing cardiac hospital that performs four to six open heart procedures daily and 4,000 angioplasties a year. It has a full ICU and CCU, with technology and equipment at the highest level. Off-pump surgeries, intravascular ultrasound catheterizations are fairly common practice there.

“I know from experience that Middle Eastern, pan-Asian and Asian cultures feel quite strongly about engineering and medicine,” said McLean. “In these cultures, education is driven toward these types of careers, so I really did anticipate that they would have a high level of practice, and indeed, they did. They were doing every single thing we do in the U.S. and often times, more effectively with greater technology.”

After a tour of the facility, McLean had an opportunity to speak with the physician director of the cardiac center, discussing the topics she was assigned to present at the conference as well as the urgency for confidence and participation in rounds and patient advocacy. She was to open the conference with a presentation titled Critical Thinking in Cardiac Nursing, and her closing talk was to be called Evidence-Based Practice in Critical Care.

“Critical thinking means that you are promoting nurses at the bedside to be independent, assertive, vigilant and the patient’s voice – even if, outside of the hospital, that might not be the historical female personality,” said McLean. “Up to this point, I had been very demure, (i.e., not offering my hand to shake, not looking in a man’s eyes, not touching anyone, and being fairly quiet), not wanting to offend anyone, but the director was quite clear that he wants the nurses there to be comfortable speaking up to actually question and defend their concerns. Even though the environment and culture outside the hospital was different for me, inside the facility, the issues and concerns are the same that are expressed everywhere. It’s so unifying to know that, no matter where in the world we are, we’re all just trying to do the right thing and attempting to integrate equality, evidence and communication into daily patient practice.”

The next day, after requesting time with bedside nurses, McLean met with about 20 critical care nurses to discuss their perspectives regarding their practice.

“At first, no one said anything,” she recalled, “When I asked directly about their relationships with their doctors, they looked to the nurse manager because (I believe) they were not really sure if it was OK to say what they really thought. With the manager’s approval to say anything they wanted, it then becomes just like meeting with a group of nurses anywhere. They want their doctors to listen to them. They say that some doctors do listen to them and some don’t—exactly what nurses in America say. They say they’d like to get rid of practice variations, that is, patients receiving different courses of care depending on who the doctor is. This was an epiphany to me, not because I thought the issues would be different, rather because I thought that acceptance levels might be different. So we talked about things like taking evidence-based practice guidelines and applying them, regardless of who the physician is, that every patient deserves the best care, and that nurses are advocates for patients. Needless to say, it was all very well received.”

What McLean heard from this particular group of nurses, practicing in an exotic place halfway around the world, was a confirmation of what all nurses face every day regardless of culture.

“I can sum this up by borrowing a phrase from my friend, Kara Adams (a fellow presenter at NTI),” said McLean, “Critical thinking is the way you take data, translate it to information, and then translate that information to drive intervention which yields outcomes. This is an excellent way to look at the challenge faced by nurses every day: Using evidence-based practice guidelines to maintain the highest level of care for every patient and remembering that we are the patient’s voice and the physicians’ eyes.”

The seminar went well, with McLean serving as both presenter and moderator in certain sessions. Attendees were mostly nurses, with some physicians, from throughout the Middle East.

“Nurses, physicians and patients worldwide have exactly the same struggles we have.” said McLean. “What’s really important is to understand the similarities of our lives, of our lifestyles, of the battles that we fight, and of the concerns we have to do the right things for patients. The differences in what we wear or what we believe have nothing to do with the critical concerns, similarities and issues we face at the bedside. We don’t want patients to be harmed. We want to be able to intervene. We need to be able to speak up, to speak out about what’s right and what’s wrong and have a way of effectively communicating about what’s happening, without fear and regardless of our gender or experience. That’s a universal desire. I can’t begin to tell you how affirming and enlightening this experience was.”

Reprinted with permission from the American Association of Critical-Care Nurses, August 2006