Patient Communication & Cultural Considerations PDF

## Patient Communication & Cultural Considerations - **The patient's family, caregiver or friends should not be used to interpret medical conversations.** - **Whenever possible, informed consent forms are provided to the patient in the patient's preferred language, even if the patient seems convers...

## Patient Communication & Cultural Considerations - **The patient's family, caregiver or friends should not be used to interpret medical conversations.** - **Whenever possible, informed consent forms are provided to the patient in the patient's preferred language, even if the patient seems conversationally fluent in their non-primary language.** - **When professional interpreters are not available, consult your facility's policy regarding the use of staff members for translating.** - **Religious objections to medical care:** Individuals sometimes decline medical care for themselves or children on the basis of religious beliefs". - **Clinicians need to be sensitive to religious beliefs and practices of patients and their families.** - **Cultural Differences:** Clinicians need to be sensitive to patient's culture, and should attempt to make collaborative decisions including the patient whenever possible, taking care when considering authority to override personal or parental preferences. - **Vulnerable Populations:** Vulnerable populations leave people at risk for skewed power dynamics in interpersonal relationships creating an environment prone to coercion - Examples include: - Pediatric patients - Aging population - Prison population - Behavioral/mentally challenged - **Situations in which patients have multiple sources of vulnerability that impact the process of informed consent** (i.e., an imprisoned patient with a mental illness) should be handled with a higher level of awareness and sensitivity. Legal department or risk management may need to be involved. ## Psychosocial Considerations - **Culture:** The learned, shared, and transmitted values, beliefs, norms, and life ways of a particular group that guides their thinking, decisions, and actions - **Types of health Beliefs:** - **Scientific or biomedical:** Belief that physical and biochemical processes cause disease and illness and medications, surgery, etc. are desired interventions - **Holistic:** Belief that a natural balance or elements within the body exists and when disturbed, disease and illness occur. Interventions relate to restoring balance, and often integrates naturally-derived products (herbs, plants, etc.) and methods (e.g., aromatherapy, acupuncture, naturopathy) with biomedical products and methods. - **Magic-spiritual:** Belief that disease and illness are caused by supernatural forces. Desired treatment includes the use of charms, chants, prayers, etc. - **Combination of above** - **Variables that influence health beliefs** - Influence patients' perceptions of health and illness, preventive practices (i.e., Immunization), and use of traditional and non-traditional healthcare modalities and treatments (i.e., acceptance or refusal of blood products) - Exist on a continuum and may change over time (i.e., patients with advanced cancer who have not responded to treatment may begin to engage in prayer) - Each patient needs to be assessed to determine his/her beliefs and identify the effects of these beliefs on planned care - **Clinicians must have cultural and spiritual awareness and competence when delivering multicultural, multi-faith care, and respect an individual's healthcare decisions even if the clinician does not share the belief.** - **Interventions that improve cultural competence in healthcare:** - Recruitment and retention of staff who reflect the cultural diversity of the community served. - Use of interpreter services or bilingual providers for clients with limited English language and literacy proficiencies. - Ongoing cultural competency training for healthcare providers. - Use of linguistically and culturally appropriate health education materials. - Culture-specific healthcare programs (i.e., Indian Health Service for American Indians and Alaska Natives). ## Patient Engagement - **The ability to effectively educate patients and families is equally important as the clinician's technical vascular access skills.** - **Patient education is much more than just providing information and is optimally provided in the context of patient engagement.** - **When patients are engaged in their own health care, there are measurable improvements in safety and quality.** ## Patient Engagement Strategies - **Patient engagement is defined as "the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care".** - **Patients are more likely to engage when the goal relates to obtaining specific information about their care.** - **Strategies to promote patient engagement include:** - encouraging and facilitating communication and participation - keeping the patient informed through bedside change of shift reports - engaging in discharge planning throughout an acute care stay - Increasing knowledge, skills, and abilities - **Better strategies are needed to promote patient involvement and engagement relative to care of central vascular access devices (CVAD).** - **Awareness and knowledge regarding the risks and consequences of a central line were explored based upon a survey of 55 patients who had a CVAD.** - 94% of patients felt comfortable with their knowledge of risks but 40% felt that the education could be improved, 22% could not recall discussing risks of infection, and 58% thought that the total time spent talking about central line associated bloodstream infection (CLABSI) was less than 5 minutes - **Patient education begins with the process of informed consent prior to CVAD placement and continues during the catheter's dwell time.** - **The responsibility for patient education requires involvement of the entire team involved in vascular access and infusion administration.** ## Informed Consent and Patient Education Prior to CVAD Placement - **Informed consent is a patient educational process involving shared decision-making".** - **The informed consent process may be limited in emergent situations possibly involving a legally authorized representative".** - **Selection of the most appropriate vascular access device occurs as a collaborative process among the interprofessional team, the patient, and the patient's caregivers.** - **Patient preference must also be a consideration in CVAD site selection, yet has not been considered a high priority when selecting a vascular access device.** - **Seeking the patient's opinion will become more relevant and as patients seek out online healthcare information and they may be more likely to express opinions and preferences.** - **Recommendations for facilitating the informed consent process include:** - Provide educational materials and a consent form (if used) at an educational level between the 4th and 6th grades. - Use a medical interpreter for non-English speaking patients. - Use appropriate resources for those with visual or hearing deficits. - Allow adequate time and opportunity for questions and answers. - Use the most appropriate method to deliver the information such as verbal. ## Expectations: Patient Education and CVAD Care - **The level or degree of patient education is dependent upon the patient's clinical condition as well as ability and the need to participate in CVAD care and management.** - **For acute care patients requiring a short-term CVAD, education may be limited based upon the patient's condition at the time of requiring vascular access and/or a short duration of CVAD need.** - **Patients, and their caregiver(s), who will be going home with a CVAD must be actively involved in care and monitoring of the device and in initial decision-making relative to the type of CVAD that will be placed.** - **Providing the education, confidence and skills to challenge health care providers who may practice suboptimal infection prevention processes may reduce the risk of infection.** - **Patients and caregivers must possess at least a basic knowledge about their catheter, including how to check for any complications, what to do and whom to contact when problems arise and how to protect the line during activities of daily living.** - **Teaching CVAD flushing and locking is common practice.** - **Depending upon the type of CVAD and patient and caregiver ability and willingness, site care and dressing changes may also be taught.** - PICC site care and dressing changes consider the risks of outward catheter migration and dislodgement when the dressing and stabilization device are removed and replaced. Routine site care may be provided in an outpatient setting or by a home care clinician nurse. - **For patients with implanted ports, care required by the patient, caregiver and family is often minimal unless the port is accessed for infusion administration. However, some patients who require intermittent infusions may desire to be completely independent with port access.** ## Assessment - **Assess, consider, and understand issues that impact the patient's ability to learn and use this information in employing effective teaching strategies.** - **Ask the patient about how he or she best learns and about their understanding of their health issues are essential aspects of assessment and should be done in a "no shaming" manner.** - **Assessment data include age, developmental and cognitive level, health literacy, culture, language preferences, and readiness to learn.** - **Culturally pertinent implications might include religious preferences, degree of and or acceptability of family involvement in care, and attitudes towards medications and supplements.**