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POPULATION SPECIFIC COMPETENCY Good Shepherd Medical Center-Marshall 1
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POPULATION SPECIFIC
COMPETENCY
Good Shepherd Medical Center-Marshall
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Population-specific staff competence is CRITICAL
to providing a safe environment for our
patients.
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Population-specific staff competence relates to possessing the knowledge, skills, ability and behaviors essential to providing care to a specific population.
On the Pediatric Unit the pediatric age groups served is a primary focus of our staff competency. However, it does not address the full spectrum of the population served.
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Beyond a patient’s age, their health care is also affected by
their socio-cultural and
geographical factors.
Health care is also influenced by
our living situation,
family dynamics,
diagnosis
and acuity.
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Age-specific interventions are the skills you use to give care that meets each patient’s unique needs.
Everyone grows and develops in a similar way or stages that are related to their age,
BUT at their own pace.
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Likes and dislikes
Feelings
Limitations and abilities
Experiences
Every patient is an individual with his or her own...
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Illness and hospitalization places stress on our patients and families.
Some patients regress emotionally or mentally when they are ill/hospitalized
By following guidelines based on age and developmental characteristics, we can help reduce the stress of our patients and families.
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Consider the uniqueness of all your patients and recognize cultural differences.
Understand what skills are necessary to respect a patient while giving care.
Ensure appropriate communication and confidentiality for all of your patients.
Identify resources you can use for developing these skills.
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Waking in a hospital bed, in a strange room with other patients near by…
Seeing unfamiliar faces and realizing they all speak a different language than you…
Having people talk to you and about you with no idea what is being said…
Seeing looks, smiles, frowns, gestures that you think might be related to you, but you are uncertain…
Not having enough money for medical care or food…
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Having people approach and touch you without a means to explain…
Being injected, or washed, or any other private or invasive procedure without being able to ask questions or state your preferences or limitations…
Hearing discharge instructions and teaching in a foreign language while someone points to a paper for you to sign…
Hearing medical advice contrary to your deep religious beliefs…
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Would you feel respected?
Would you consider that being treated in a dignified manner?
Would you trust your caretakers?
How would you know what was wrong and how to get better?
Would you feel as though you had rights?
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CULTURE: The values, beliefs, norms and practices of a particular group that are learned and shared and that guide thinking, decisions and actions in a patterned way.
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ability & disability, age, color,
ethnicity, religion, gender,
job category, class status,
national origin, race
and sexual orientation
DIVERSITY
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Environmental Control
perceptions that a person has about the ability to direct factors in the environment and the systems and processes that are part of it.
Health behaviors and disease patterns differ with cultural groups.
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Interpretive Services – know how to access and use both live and telephone services
Language Services – printed materials, visual aids
Social Work and Pastoral Care Departments
HIPAA Guidelines –guidelines that ensure confidentiality for patients’ health information. All employees, students, and volunteers are responsible for following these guidelines, which state that confidentiality can be maintained by only sharing MINIMUM information necessary.
Outside Resources – accessed through Case management
It is impossible to memorize all the specific information about
every culture.
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Greet patients with their names – avoid being too casual or familiar
Introduce yourself by pointing to yourself and saying your name
Note and observe any hesitations or special requests (i.e., no male caregivers for a female patient
Determine understanding by hearing person repeat or demonstrate instructions
Do not talk to other staff in patient’s area using a language he/she will not understand
Do not make assumptions about eye contact, space, gender issues or any other cultural factor based on your opinions.
Some Basic Tips for Overcoming Initial Cultural or Communication Barriers
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Pay special attention to any efforts made by the patient or family to communicate
Use an available resource to get a “quick glimpse” into the patient’s culture or language
Use available visual aids
Maintain confidentiality by using “minimum necessary information” even with interpreter
Continue to provide non-judgmental care!
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Religious, function, andcomposition are commonbarriers.
Socio economic status as well as educationallevel can be a barrier.
Differences in family structure can be a barrier.
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Family centered care
Our interventions are structured around the entire family unit – with the patient as the center
We must respect the various styles, abilities, resources, communication patterns and values that all families exhibit differently.
Our goal is to Individualize patient care to best supportthe family structure – without prejudice or judgment on our part.
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R-E-S-P-E-C-T
Find out what it means to YOU!
Know yourself – your own attitudes, beliefs, and even prejudices…
Keep an open mind…
Acknowledge and celebrate differences –all cultures and groups have strengths and weaknesses…
IT STARTS WITH YOU!
No 2 people are created alike
Communication – language, patterns, gestures and facial expressions, decision-making
Personal Space – how close is too close?
Social Organization – how a group mourns, celebrates, learns, lives, etc.
Time – past, present, or future orientation
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Communication and culture are intertwined
Written and oral language, gestures, facial expressions, and body language are the means by which culture is transmitted and preserved.
Patterns are developed early and affect an individual’s entire life.
Healthcare providers should recognize common cultural patterns, but not assume that all members of a cultural group use the same means of expression.
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It includes the space and objects within that designated area. This differs with culture and is important to know and respect when providing physical care.
Personal Space – is the area surrounding a person’s body.
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Social Organizationtakes into account patterns of behavior that people of various cultures may exhibit during such life events as birth, puberty, childbearing, illness, disease, and death.
Healthcare workers need to understand the profound impact this can have. Beliefs, values, and attitudes related to these events result in traditions and rituals that follow an individual through life.
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Time can be perceived as concrete orabstract.
Cultural groups may be differentiated according to whether their time orientation or behavior is related primarily to the past, the present, or the future.
Time
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Southern African Americans – health is considered a gift from God and illness retribution for sin.
Chinese believe that health is based on the balance of female energy (yin) and male energy (yang.) Disharmony between the two is thought to disturb the body’s functioning.
Mexican patients may believe in “hot” and “cold” forces that may be thrown out of balance in illness.
In many Western cultures, calling an elderly person by his first name is considered rude.
(Ask a patient how he wishes to be addressed.)
Some Basic Tips for Overcoming Initial Cultural or Communication Barriers
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Some families especially in rural areas, may be challenged for basic necessities such as heat, water, and food.
Native Americans or Southeast Asians may view expressions of caring, such as hugging, as intrusions of personal space. They may view it as discourteous to make direct eye contact or to stand too close.
Thais or Filipinos may nod their head in a “yes” manner, but it does not necessarily mean they understand. People in these cultural groups VALUE preserving harmonious relationships and avoiding confrontation. They may nod to avoid offending or embarrassing anyone.
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Greet patients with their names – avoid being too casual or familiar
Introduce yourself by pointing to yourself and saying your name
Note and observe any hesitations or special requests (i.e., no male caregivers for a female patient)
Determine understanding by hearing person repeat or demonstrate instructions
Do not talk to other staff in patient’s area using a language he/she will not understand
Do not make assumptions about eye contact, space, gender issues or any other cultural factor based on your opinions.
Some Basic Tips for Overcoming Initial Cultural or Communication Barriers
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Strictly observant Jews may obey dietary laws, that prevent the mixing of milk and meat, and forbid pork or shellfish.
Jehovah’s Witnesses do not accept blood transfusions and refuse to eat foods that contain blood.
Muslim and Hindu patients may also follow religious dietary restrictions.
Muslims pray five times a day and must face east when doing so
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Your Responsibility…
Offer culturally competent care
Respect differences
Maintain confidentiality
Know and use your resources
Ensure patient appropriate communication
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HARRISON COUNTY CENSUS (2011)
74.4% White persons22.2% Black persons 1.2% American Indian and Alaska Native persons 0.6% Asian persons 0.1% Native Hawaiian and Other Pacific Islander persons 1.4% Persons reporting two or more races 11.9% Persons of Hispanic or Latino Origin
And 13% of the population is 65 or over
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It is important to understand the family roles, family
dynamics, and the role faith plays within our Hispanic
families.
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Understanding “La familia”We must understand roles and relationships within the Hispanic family to help foster positive communication, patient/family cooperation and interaction with GSMC staff. This understanding will also assist compliance with treatment or treatment outcomes.
The importance of extended familyHispanic families believe it is valuable to have extended family support and presence during times of crisis.
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Hispanic Gender Roles
Mother’s Role “The Nurturer”Determines when a family member is ill and needs care
Father’s Role “The Decision Maker”Holds the greatest power in the majority of Hispanic families and gives the permission to seek treatment.
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FAITH, RELIGION AND TRADITION
Faith and the Church are powerful sources of hope and strength for many Hispanic families. This may also impact how they interpret and accept our help
Roles of faith, religion, and tradition in healthcare
Religious beliefs of a family may require practices that are unfamiliar to GSMC staff. We must respect the families need to uphold their belief while continuing to provide the best possible care for our patients.
There are many traditional religious home “treatments” that can impact patient outcomes.
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Communication and respect
REFRAIN from hand gestures. Different hand gestures can have different meanings across cultures.
Please make eye-contact.
Head nodding could mean respect for authority not necessarily understanding.
Touch, hugging should be done only after establishing a relationship with a family.
Encourage questions. Healthcare workers are considered authority and asking questions could be viewed as disrespectful.
Doctor/Patient Relationship needs to be based upon mutual respect. Once established, this will lead to better treatment outcomes.
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Opposite Concepts Collide (Hot and Cold)
For example, a culture could treat fever with blankets to sweat it out, whereas our treatment is to remove layers to cool the body.
“Mal de Ojo”- Strictly interpreted as the evil eye: Be very careful how we look at patients. This can be interpreted as looking down upon. Make other contact as well by talking or interacting.
Safety: Patients and families may use bracelets or beads as protection against the “Mal de Ojo” (Evil Eye).
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APPROACHES TO TREATMENT can vary from culture to culture
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What have they been using at home or here as their treatment
of choice?
DIET AND ALTERNATIVE REMEDIES
• Herbs
• Vitamins
• Fruits
• Spices
• Teas
• Plants
• Prayer
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These are services often depended upon and may be consulted after leaving
HealersHerbalistsMidwives Massage TherapistsPriests
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Interpreters, Translators, Advocates, and Resources help to bridge the gap.
But, interpretations and translations are not always simple or clear cut.
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Religion, diet, family structure all play a part in our interactions.
We have to bridge the gap between us as a hospital and healthcare providers and the various cultures we serve.
IMPORTANT BELIEFS AFFECTING HEALTHCARE…
Self-reliance activities and nature predominate over people, many believe that it is best to let nature heal.
Bureaucratic forms foster fear and suspicion of health-care providers.
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For many, pain is something that is to be endured and accepted stoically. It is important for health-care providers to approach individuals in an unhurried manner.Slower pace is better received.
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Patients and families with Low Health Literacy
“The ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Healthy People 2010
Prevalence across 85 medical studies26% low health literacy20% marginal health literacy
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With borderline or illiteracy, how does our patient understand….
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Pill bottles
Appointment slips
Informed consents
Discharge instructions
Patient/health education materials
Insurance applications?
Common medical words that patients with limited literacy may not understand:
Blood in the stoolBowelColon
GrowthLesionPolyp
RectumScreening
Tumor
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Some patients seek help only when illness is advanced.
They have difficulty explaining medical concerns.
May use the excuse, “I forgot my glasses,” when actually they cannot read.
This leads to lack of follow-through with tests/appointments.
They seldom or never have any questions.
A patient may identify drugs by pill color and shape rather than by name and then does not know purpose of each medication.
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WHAT CAN YOU DO?
Limit information (3-5 key points)
Use “living room” language
Be specific and concrete, not general
Demonstrate, draw pictures, use models Use a “Show Me” approach to confirm understanding
Be positive, respectful, caring, sensitive, empowering
Never “talk down” to anyone, patient or coworker
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Most American adults read 3-5 grade levels lower than the highest grade
level of schooling completed.
(Average reading level in US is 6-8th grade level)
ElderlyMinorityRecent immigrantsNon-English speakersLow-incomeSchool drop-outs
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65 Years and Older Age Group but with a wide variation in mental ability, physical ability, and health status
• The age of the patient does not automatically dictate his or her health status.
• Some elderly patients are still quite active, playing golf, swimming, walking, playing tennis, etc.
• Some elderly patients are very debilitated due to chronic illnesses, and may require home care or to be in an extended care facility.
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Do not stereotype the elderly person…or any person.
It is particularly important not to presume that an “elderly” patient is frail, weak, and helpless.
A thorough assessment will help identify the health level of the individual.
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" We have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams."
-Jimmy Carter
