Week 2 Discussion: Reflection on Cultural Awareness (Graded)

Hello Professor and Class, 

         Therapeutic communication is an essential part of nursing interventions and care. “Learning to ask questions that encourage more than a yes or no answer is the first step. Actively listening for understanding is the second step, and verifying the information received is the final step” (Lesson 2). Therapeutic communication is an interaction between a healthcare professional and the patient that helps to achieve positive health outcomes (Fite, 2019). “The main factors influencing the therapeutic communication related to the patient, nurse, and the organization were disease-related change, use of an unfamiliar medical term and ward’s condition, respectively. Educational status, language difference, education difference, and perceived patient view scores were found as significant predictors of therapeutic communication between nurses and admitted patients” (Fite et al. 2019).

        Nurses’ role is to provide patient-centered care that involves purposeful interpersonal interactions. We spent at least 30 percent of each shift providing direct care. Effective communication is an integral part of good practice, improves patient’s knowledge and satisfaction. In the Chicago area where I work, we encounter patients from multiple cultural and ethnic backgrounds. Nurses are aware of cultural diversity, but the communication barrier is frequently frustrating. If the first language of the patient who is admitted to the hospital is not English, they are supplied and accompanied by an “interpreter on wheels”. It is a tablet through which staff can connect with interpreters for about 50 languages. Both audio and video are available. “Interpreter on wheels” is helpful during assessments and communication but it has some disadvantages as well. Communication with a patient requires much more time and it’s very limited with confused patients.

         Recently, an elderly Polish-speaking patient with dementia and altered mental status was admitted to my unit. From the report, I learned that he was agitated, confused, restless, and required soft restrains in previous shifts. Since I speak Polish fluently the patient was assigned under my care for the night shift.  I was worried about his behavior and safety. Surprisingly, he turned out to be the sweetest man. He was calm, complaint, and relaxed all my shift. Took all scheduled medications, that he was previously refusing, and even let me start a new peripheral IV on him. I found out that the patient not only didn’t understand English but he was heard of hearing and had delayed responses which affected his communication. “Interpreter on wheels” was not effective in that case. In previous shifts, the patient demonstrated aggression due to frustration and lack of understanding. Once he heard a familiar language his behavior drastically improved. This patient would benefit from a family member at the bedside 24/7 or Polish-speaking staff that the hospital could not provide.  In my eleven-year practice,  I encountered a number of similar situations where patients with dementia demonstrated noncompliance and agitation due to the language barrier. If possible we encourage family members to assist but that is not always available.

Magdalena

References:

Fite, R., Assefa, M., Demissie, A., Belachew, T., (2019). Predictors of Therapeutic communication between nurses and hospitalized patients. Heliyo. 5(10). https://doi.org/10.1016/j.heliyon.2019.e02665Links to an external site.

Good afternoon Professor and class!

As I read this week’s reading, I was able to reflect on ways that I have applied cultural awareness in my nursing care and how I will change some of those ways to provide more culturally congruent patient outcomes in the future. I believe this all starts with the patient assessment as was explained by Andres, Boyle, & Collins, 2020. As nurses, we gather so much of our information by performing a full and/or focused head-to-toe assessment. In doing so it is of utmost importance for us to recognize non-verbal cues the patient may be exhibiting. In turn, we as nurses also need to take into account our own non-verbal cues we may be projecting while caring for various ethnic backgrounds. One thing I briefly spoke about in our last discussion was the idea of involving providers of the same ethnic background as the patient as this will provide a more trusting nurse-patient relationship. Equally as important is knowing the patient and their family truly understand the diagnosis and implications for the hospitalization. This is where teaching comes into play. When teaching these individuals, we have to recognize that aside from a communication barrier, there may be other barriers present such as learning style/health literacy and comprehension, familial involvement, religious beliefs/practices, as well as how an individual expresses their emotions.

One example that came into mind was when I took care of a Chinese woman who was admitted to the hospital for newly diagnosed breast cancer. She only spoke Mandarin but her 2 children were at the bedside most of the time. They both spoke fluent English, so they assisted with most of the translating for basic communication needs. One thing I noticed were these jars of some sort of foul-smelling liquid and the patient complained of being cold even though I personally felt the room was scorching hot. When I performed her physical assessment and asked if she was in pain as I noticed her grimacing many times throughout the assessment, she would simply shake her head “no.” However, her son would constantly tell me that his mother was in pain and questioned why I was not providing her relief with pain medication. I explained to the son that his mother had to verbalize that she was in pain in order for me to do so. He replied, “clearly she’s in pain. You can see it on her face.” Additionally, I communicated to the son that I was waiting for a Mandarin-speaking interpreter to aid me in asking more focused, pertinent questions to figure out if she was in pain or if something else was going on. Once the Mandarin-speaking interpreter came to the bedside, she was able to ask the patient more focused questions relating to the patient’s perceived pain. The interpreter did so by asking open-ended questions in order to determine what the word “pain” meant and how it affected her with respect to her cultural needs.

In this situation, I respected the family’s suggestion that their mother was in pain by being considerate of their needs as well as their mother. By engaging a member of the healthcare team that was of the same cultural background as the patient and her family showed my respect for their cultural needs and practices. I was able to gain the trust and assurance of the patient so that she remained confident with the healthcare team.

Moreover, I inquired about the jars of liquid on the patients’ table. The family explained that it was an herbal remedy used when one was sick. I performed some research of my own to ensure the herbs used did not have serious interactions with the medications she was currently taking. After communicating with the patients’ direct provider and the pharmacist, it was deemed that the herbs were not harmful to the patient’s current medication regimen. Had I not advocated for the patient, I would not have gained her or her family’s trust, thus, not allowing me to provide culturally competent care.

https://chamberlain.instructure.com/courses/77751/pages/week-2-lesson-communication?module_item_id=11070827

Cultural awareness is important in nursing practice. Every nurse should be sensitive to the individual differences of our patients. I work in a New York hospital which the population is diverse and is important for me to understand how to deal with my patient. A nurse-patient relationship will depend on how the nurse will treat the patient put into consideration what the patient believes and values. According to Baker “The effectiveness of the care provided depends on the nurse’s awareness and sensitivity”. As we provide care to our patients one has to do a self-assessment on cultural awareness for us to appreciate the differences, we all have. “Remember that part of true cultural competence is not making assumptions but learning about the individual patient.” (Week 2 Lesson)  

I was taking care of a female patient with language barrier. She had not passed any urine though out my shift, I would try to offer a bedpan as she was bed-bound but she never agreed to use it. At some point, she looked to be in distress, and I would think she was in pain and give her some pain medication which seemed not to help. I did a bladder scan and there was more than 400 hundred urine in the bladder. Informing the doctor order to straight Cath the patient was put. At this point, I had to look for an interpreter to explain to her we needed to do the procedure because she had not passed urine. Through the interpreter, I came to learn that she been holding a lot of urine and she did not want to use the bedpan with me as she felt I was too young to see her private parts and at the same time she did not want to embarrass herself by making a mess on the bed. I had to look for an older female nurse to help her out and she voided without any help. As a unit, we agreed that all patients with language barriers should be assessed and use a hospital interpreter to understand the special needs of our patients. We also went ahead and prepared picture communication charts that would have the basic needs and the patient would use and point out their needs. This would have been prevented if an initial assessment was done in the presence of the hospital interpreter rather than gathering a few information from the relatives.

For our patients to be comfortable they should always know that there are treated well, understood and their needs put into consideration when offering out care.

Reference

Baker C: Cultural awareness in nursing. Retrieved from https://pubmed.ncbi.nlm.nih.gov/1764675/Links to an external site.

Week 2 lesson: Cultural Competence in Health History. Retrieved from https://chamberlain.instructure.com/courses/77751/pages/week-2-lesson-cultural-competence-in-nursing-assessment?module_item_id=11070816