Strategies on Cultural Competence

In my own nursing career as a supervisor for field case managers, I have encountered patients and staff that come from diverse cultures. Every two weeks, our entire region would participate in something called Grand Rounds.  During those rounds, our medical director would review four cases that had been submitted for evaluation and best treatment options.  My team consisted of different cultures.  We had some wonderful nurses from different Caribbean Islands, some of them had a very strong accent, but that did not stop them from providing good care.

During one of our grand rounds, the medical director selected two of my case managers to present their case.  This case was presented in our own team meeting and we thought it would be a great one to present.  The one case manager we will call her Ms. R. presented a case about a member that had too many cats in the home and she was having difficulty staffing the case with home health aides because no one wanted to go in the home with so many cats. The medical director gave his evaluation of the case and the case was closed with the new information for the nurse case manager to implement.

During a manager meeting with about six other managers, the topic of case presentations came up and how each team needed to submit two cases per week, even if they were not selected for grand rounds.  A manager from England, who spoke with an English accent, stated that my team presented a lot of cases all the time.  I  stated that our strategy in our team meeting was to bring two cases every week so that everyone had a chance to comment. It also served as a good practice for the nurse presenting the case if the member was selected for grand rounds.  The English nurse manager asked me how I even understood Ms. R. and a few other staff from the islands that I had.  I politely let her know that I did have a diverse team and every one of them was a great nurse and social worker and did their jobs quite well.  As for understanding them, I listened to what they were saying intently and I did not multitask when they were speaking so that I could capture every word they said. Her response was I am glad that they are on your team (Clark et al., 2011).

I did resign from this position and unfortunately, four of the team went to this one manager and the other nine went to someone else.  But of the four there was one that was from Haiti, one from Grenada, one from Puerto Rico, and the other one was African-American.  I heard from all four about the poor treatment they were receiving from this manager. Of I course could only listen since I no longer worked there, but this was a perfect example of how not all nurses follow the code of respect for other people’s cultures.

With patients, it is the same thing, as nurses,  we are not always going to understand what someone is saying whether it is a language barrier, dysphagia from a stroke, or dementia, but we need to read the body language.  We need to fine tune our ears to try to understand what the person is saying. Living in Florida I am exposed to many cultures.  I myself am of Hispanic descent and although born in the states, I understand the diverse cultures that are here.

In integrating health teachings, many materials are available in Spanish and Creole, for the ones that are not, the use of translation companies are available through hospitals or managed care companies to help with the teaching that will be offered to the patients.

References

Clark, L., Calvillo, E., De La Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011, May-June). Cultural Competencies for Graduate Nursing Education. Journal of Professional Nursing, 27(3), 133-139.

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A Review of a Nurse’s Role

A nurse can play three different roles as part of an interprofessional team.  The three roles consist of a nurse, nurse leader, and nurse educator.   The inter-professionalism team consists of other healthcare workers as well, not just nurses (Sommerfeldt, 2013). However, as nurses, the roles can be at different levels depending on the patient’s condition.  At my previous job, I worked as a complex case manager.  The team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers, and nutritionists.  The nurse case manager managed the patient but if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs.  If the member had psychological issues or other financial issues that required the need of a social worker or behavioral health specialist this referral would be added as well.  There was collaboration on the plan of care and all participated because we all were looking at the patient as a whole, not just as the part that each discipline took care of.  If a member was not able to pay his light bill or water bill due to financial difficulties until those needs were met through resources, any teaching that the nurse would do would be in vain.  A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance, the nurse is playing the role of the nurse leader.

When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration, and other treatments.  The nurse’s role in the interprofessional team may consist of the doctor, physical therapist, and dietitian, this would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially.  The patient may be on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietitian can help the patient understand the diet and the nurse can reinforce the teaching.

The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting.  This type of setting also has multiple specialties that can follow the patient.  In this instance, the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar, or blood pressure.  The nurse educator can document what the patient learned based on return demonstration in the plan of care.

All three roles bring value to the scenario that they are in because the nurse will be around the patient most of the time.  In each role, the nurse is responsible for all aspects of the patient’s care.  Regardless of which role the nurse is playing, working on an inter-professional team is a style of partnership that allows decision making to be collaborative (Sommerfeldt, 2013).  It takes many people to working together to get a patient discharged to his home.

 

References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

Feelings of Anxiety

Many times as I review situations I have been involved in or a colleague has been in, the problem is always about the anxiety of one department telling another what to do and who has more authority or say in the matter.  What I find to be helpful, is that when one department is going to do work in another department, the manager should be speaking with the other manager first.  This way the managers can discuss exactly what is happening and when, so that if there is a bad time and they are able to work around the job that needs to be done, it can be resolved before the workers come out.  Many times things are approached from one manager to another with anxiety because a situation has occurred (Miller et al., 2008).  There are issues with authority over which department has more control of a situation.  As I always say, one department is always a guest in another department’s meeting or space, if this respected, then the relationship can be a smooth one whenever work needs to be done.

References

Miller, K. L., Reeves, S., Zwarenstein, M., Beales, J. D., Kenaszchuk, C., & Conn, L. G. (2008, June 2). Nursing Emotion Work and Interprofessional Collaboration in General Internal Medicine Words: A Qualitative Study. Jan Original Research, 333-343.