05 Oct Respond with ½ page to each post. 1 apa source pe
Respond with ½ page to each post. 1 apa source per response. Post 1. Professor and classmates,Communication is the key to understanding an individual’s needs and wants. Miscommunication leads to mistrust and often fear. We see this every day in our society. As our country becomes more diverse it is leading to a growing hostility and resentment. It is important for people to try and understand each other and respect individuals.The hospital setting is a good example. If a doctor or nurse miscommunicates it can lead to an improper treatment to a patient. According to the ANA it is part of our competencies to effectively communicate with our patients via specific tools or certified interpreters. “Existing research has established that language barriers can be a threat for patient safety, language proficiency should be noted down in patient records, and that language barriers should preferably be bridged through the use of professional interpreters.” (Van Rosse, De Bruijne, Suurmond, Essink-Bot, & Wagner, 2016, p. 46). My hospital has become proactive in encouraging its staff members who are able to speak more than one language to become certified interpreters. A study was conducted and it was found that staff as well as patients disliked using the interpreter phone service. We are discouraged from using family members to interpret information. According to CLAS standards, language assistance needs to be offered at no cost. This includes competent interpreters as well as media or print out information packets. We have initiated a process during the admission to determine the patents preferred language and their literacy level in order to optimize their healthcare. It has been determined that a lack of understanding can lead to poor outcomes. Especially not following discharge instructions.”The present study showed a wide variety of patient safety risks in hospital care for patients with language barriers. These risks can be reduced by adequately bridging the language barrier which, in the first place, asks for adequate detecting and reporting of a language barrier.” (Van Rosse, De Bruijne, Suurmond, Essink-Bot, & Wagner, 2016, p. 53) I would encourage my peers who are bilingual to take the 10 minute test to become certified. It would help our workflow and prevent errors and inaccuracies in our area. ReferencesAmerican Nurses Association. (2015). Nursing: scope and standards of practice (3rd ed.). Silver Spring, MD: Author. pp. 31-37; 69-70; 79-81 Van Rosse, F., De Bruijne, M., Suurmond, J., Essink-Bot, M., & Wagner, C. (2016). Language barriers and patient safety risks in hospital care. A mixed methods study. International Journal of Nursing Studies, 54, 45-53. doi:10.1016/j.ijnurstu.2015.03.012 https://www.thinkculturalhealth.hhs.gov/clas/standards (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site.. Post 2 Hello Professor and class,Clinicians are increasingly faced with providing care to a multicultural community that is complicated by cultural and language barriers. This is a vulnerable population where nursing can advocate and effectively address cultural miscommunication. (Chamberlain Lesson 4) . We are challenged to provide safe, quality healthcare for all patients and this means we must understand how each patient’s cultural background affects his or her health beliefs, behavior and if their understanding of the English language is accurate. We cannot educate if our patients do not understand us and this lack of education results in poor health outcomes increasing the disparity of quality outcomes in the health care system. The creative, client-centered care plan encompasses clinicians from a variety of disciplines that address all aspects of patient needs. Safety, improved quality outcomes, and education are all enhanced by collaboration with others in their respective fields. Each discipline brings a unique perspective and expertise to meet patient-centered goals. As a home care supervisor, I oversee most communication between the members of my team which includes RNs, PTs, OTs, STs, CNAs, and MSWs. Patient advocacy begins with collaborative communication for streamlined patient-centered care and cannot be stressed enough when considering clients from different cultures. It is important to identify the cultural barriers to patient compliance and make sure all team members are aware of the challenges. Educating my staff so they understand the impact of cultural influences allows modifications of my teams care plan to create an approach that is more likely to result in less patient resistance and quality outcomes.The National Culturally and Linguistically Appropriate Services Standards (CLAS) provides a framework to address the disparity of healthcare in populations that are culturally diverse from the American population. Standard 7 states healthcare organizations will, “Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided” (U.S. Department of Health & Human Services, 2019). Access to (CLAS) changes the dynamics of the patient/nurse relationship and leads to greater advocacy. The focus and goal of this service is to level the educational playing field for all our clients by providing quality instruction to patients regardless of their cultural heritage.There is a difference between interpreters and translators, they are not interchangeable. A translator converts information into the desired language but does not attempt to embellish or explain it. An interpreter goes further than a simple translation to provide cultural meaning to what is being communicated. For example, we have a large elderly Cuban population that uses some form of folk medicine to manage their medical issues. Cuban patients may seek out the care of brujos or brujas (wizards or witches), yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobradores (similar to physical therapists) to address medical conditions (Juckett, 2013). In addition, many Cubans practice or have been exposed to Santeria which was a religion developed by slaves throughout the Spanish Caribbean which combined their belief in spirits with Catholicism. Santeria relies on the wisdom of orishas, or spirit saints, to provide guidance. Every person has one or more orishas, and by interacting with their orishas, a person can gain insights and new understandings that improve their understanding of self, community, and purpose (Davis & Georgetown University, 2018). An interpreter would put explain these influences to the nurse.You cannot advocate for the patient you do not understand. The challenge to the healthcare worker in the American medical culture of ‘evidence-based this’ and ‘peer reviewed that’, is to respect this patient and understand these deeply held beliefs and culture do impact the patient care the health care team will attempt to deliver. The comprehensive clinical team should include a qualified interpreter if needed to gather a baseline of general health and then create a care plan that has a holistic approach. Identifying a lead clinician for consistent follow up would be important in building a trusting relationship. It would critical to have an accurate med reconciliation that includes any herbs or home-made remedies the patient considers a part of their personal health care routine. In addition, it would be important to ask this client when they would seek the care of brujas, verberas, hueseros, a community non-certified midwife or sobadores instead of calling the physicians office. Identifying the last time the services of one of these alternative healers were used would be important to know, was it 15 years ago in Cuba or last week? Engaging the patient to collaborate with the creation of this care plan would increase the likelihood of compliance and desired long-term behavioral change. Using techniques like the ‘teach-back’ method could identify if the patient is truly understanding what is being taught (U.S. Dept of Health & Human Services, 2015). Over time, a respectful relationship protects clients dignity and will increase buy-in for the plan of care.In home care, we sometimes go into homes where patients do not have English as a primary language or do not speak any English. We have access to a phone translator but that is incredibly arduous going sentence by sentence and if the patient has a hearing problem the phone conversations are torturous. It is so easy to look at the bilingual family member in the room for help but they may not be translating what you or the patient is saying and this violates the CLAS standard 7 ( U.S. Department of Health & Human Services. (2019).). As I researched this, I found numerous, well documented, incidents that revealed poor outcomes when trained interpreters were not used. For example, in 1980 a Hispanic 18-year-old was brought to the hospital and was in a coma. The staff interviewed his Spanish speaking family for a history and the family reported they believed he had food poisoning. A bilingual staff member translated “Intoxicado” (poisoned) as “intoxicated” (drunk). The physicians treated him for an alcohol and drug overdose, but he actually had an intracerebral hemorrhage. The delay of treatment had a tragic outcome and left him a quadriplegic (Rice, 2014). To help with this problem, our agency added a google app the IPads that can translate out loud what we are saying into the language needed and vice versa. While this has been a benefit for translating during our nursing visits, this still lacks the cultural quality ‘spin’ an interpreter communicates during the teaching or conversation.In what ways are you and your peers using these standards in your areas of nursing practice?One strategy our home care uses to observe these standards is to require the clinicians on each team to provide a handoff report in a centralized electronic medical record (EMR) directly attached to the patient’s chart which the clinical team uses. When a patient is admitted to home care, collaborative communication with each clinician seeing that patient within the first 5 days of admission creates a patient-specific plan of care. Any case that requires an interpreter, or is identified with a significant cultural influence that could impact care has a Medical Social Worker attached to the case. They assist to identify culturally appropriate education for the team caring for this client. She will visit the client and then chart her findings with any culturally significant strategies needed to make each visit meaningful and optimize patient buy-in. After each clinician assesses a patient, their evaluation can generate critical contributions towards the development of a customized care plan for the patient. Once this is done, my team has multidisciplinary team meetings twice a month with a focus on high-risk patients which these patients qualify. In this forum, concerns regarding cultural sensitivity and barriers, safety, patient decline or progress, achievement toward patient-centered goals, advancement towards discharge are addressed and action plans are updated. Effective cultural education and open communication within the team is essential to achieving successful patient outcomes and to keep our patients safe.Some of the tools we use in home care is the ‘teach back’ method. What this looks like in the home care setting during patient care is asking the patient or interpreter to repeat back what you said during the informed consent process when discussing specific orders or after any patient educational teaching. The repeat-back process is a very effective way to determine the extent of the patient’s understanding (U. S. Department of Health and Human Services, 2015).Standard 8 of the CLAS instructs the professions nurse to “Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area” U.S. Department of Health & Human Services. (2019)..Providing education material in the patient’s language is fundamental. But with all the above to consider, we must also assess understanding of the material. One idea I have wanted to introduce to our agency is a simple teaching tool known as “Ask Me 3”. The professional nurse should be able to ask these 3 questions after you believe you have clearly instructed on something. The patients’ answer can quickly identify if they have caught what you have laid down, or if clarification is needed. (Becenti, 2017)I have provided a link to “Ask Me 3”, I hope you find this tool as simple and helpful as I did. http://www.npsf.org/askme3/Resources:Becenti (Navajo), A. (2017, October 05). Health Literacy Month Brings Attention to Importance of Delivering Clear Information to Patients | October 2017 Blogs. Retrieved May 25, 2019, from https://www.ihs.gov/newsroom/ihs-blog/october2017/health-literacy-month-brings-attention-to-importance-of-delivering-clear-information-to-patients/Chamberlain Lesson, week 4, 2019. https://chamberlain.instructure.com/courses/43114/pages/week-4-lesson-foundational-concepts?module_item_id=5495690Davis, C., & Georgetown University. (2018, April 16). Santeria, Culture, and Syncretism in Cuba. Retrieved May 25, 2019, from https://berkleycenter.georgetown.edu/posts/santeria-culture-and-syncretism-in-cubaJuckett, G. (2013, January 01). Caring for Latino Patients. Retrieved May 25, 2019, from https://www.aafp.org/afp/2013/0101/p48.html#sec-1Rice, S. (2014, August 30). Hospitals often ignore policy on using qualified medical interpreters, patient safety is endangered. Retrieved May 25, 2019, from https://www.modernhealthcare.com/article/20140830/MAGAZINE/308309945U.S. Department of Health & Human Services. (2019). CLAS Standards. Retrieved May 27, 2019, from https://www.thinkculturalhealth.hhs.gov/clas/standards
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