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.

Importance of Professional Communication

Professional communication is very important when we are dealing with a patient’s health.  In this virtual world that we live in where more and more people are working in the field and from home, it is important that we maintain a standard of etiquette when speaking with people via electronic mail and in person. Rapid responses without thinking about them first can come across incorrectly in person and in writing.

In every organization, there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion.  One barrier that is seen in managers, is the inability to show respect to other team members and allow a learning environment.  This is a prime example of a barrier in a learning environment that will hinder an employee’s growth and affect the quality of patient care (Rubenfeld & Scheffer, 2014).

As a former manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaborated on cases together.  But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was a multidisciplinary team.  In this type of team, there is only individual thinking in the group, meaning their way and no other opinions.  The focus will be on tasks and check off systems regardless if it is feasible to do (Rubenfeld & Scheffer, 2014).

Nurses do have the ability to be leaders and educators of a system that will stimulate change if they are assertive. In order to make an impact, a good team of interprofessional people is needed (DeNisco & Barker, 2013).  At the end of the day, the patient is the one who counts and the reason why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans, and disgruntled employees.

In our team, for instance, a good way that we used to incorporate learning weekly was having one person do a case study and they would team up with another person on the team to present the case study on a difficult patient.  During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review.

There are many teaching and learning styles that we can use to teach patients. The important thing is that no matter what we feel is our way or learning, not everyone will learn the same way.  Therefore as the nurse, we need to explore what is that patient’s learning style and teach in that way.  Another assessment the nurse can make in the home care setting is the readiness to learn.  If a patient is having difficulty paying his electric bill, he may not listen to the teaching on a diabetic diet and the foods that he is to be eating or buying, because he may not have the resources to purchase them.

In conclusion, managers and leaders need to be able to figure out a way to engage their teams, show them respect, praise them for a job well done and be able to involve them in the overall goal as a team vs. a transactional leader that dictates and causes poor morale amongst the team.

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Rubenfeld, M. G., & Scheffer, B. K. (2014). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

When a Patient is in Pain

Have you ever thought about your patients in the hospital that are under severe pain?  When someone is in pain, the painful stimulation must be removed in order for them to function. In looking at the activities that we do on a daily basis like brushing our hair, getting dressed and many others, I can see how many would not be motivated because of the pain that they are in.  When physical therapy comes around, they at times lose their motivation because it is too painful.  But if we write the plan of care and recommend to the physician that they have medications given to the patient about 20-30 minutes before therapy, then the patient may be able to work through the therapy that may be painful otherwise.

Some patients who are being cared for in the home setting may have experienced an injury or disease process that prevents them from taking care of themselves and they get frustrated.  This is when we can show the patient ways to remain independent and give them choices when possible.  For instance what foods they like to eat within their diet or what days they want their bath. Everything depends on when they have the help available, but at least whenever they make a decision, we should give them that option.  We can help the patient have some decision making power (Alligood, 2013).

 

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947

Cultural Differences and Beliefs

Our beliefs in about different cultures and patient care should be respect. When I worked as a nurse in labor and delivery, I met parents from different socioeconomic stages and cultures.  During the time that a mother would be in labor, it was interesting to see how the woman from one culture perceived pain vs another culture, as well as the role that the father played in the whole birthing process.  As nurses, we may not understand everyone’s language or their culture, but we are required to use cultural competence to be able to take care of our patients.  If we are too quick to judge another culture because our beliefs are different, we may not be able to objectively take care of our patient.  For example, there are some religions that do not believe in blood transfusions, however, as an adult, they can sign for themselves stating that they are refusing medical treatment and they understand the medical consequences of refusing it.  As nurses, our treatment of the patient and their family after refusing a transfusion should not be different.  We should be respectful of their religious beliefs.

Our own beliefs as a nurse can impact a patient in many ways.  For instance, if you find yourself in a Christian hospital where praying is okay with a patient and encouraged, and you feel comfortable asking the patient if they would like to pray, then you would do that.  Now in the same situation, if you are a nurse that is not very religious but works in a Christian hospital and a patient asks you to pray with them, it can be very awkward for the nurse.  The nurse can let the patient know that she will stay there as they pray and a warm touch of the nurse’s hand on the patient’s hand can be all the comfort that the patient needed.

When assessing a plan of care for a patient, the work situation, their lifestyle, culture, and religious preference will all affect how the plan of care is initiated.  The plan of care involves the patient with his or her own patient-centered goals.  These goals should be measurable and attainable.  There should be an intervention as to how the patient will achieve his or her goals. In the care plan,  there should be an end date as to when the goal is perceived to be completed.  Lastly, at the end of the evaluation date, there will be a review to see if the client was able to fulfill his goal and how much progress they have made.  If they have not fulfilled their goal, what barriers prevented them from achieving their goal?  Then a new plan of care should be started so that the nurse can keep track of the goals and formulate time frames to complete the old ones that haven’t been done.

The medical model defines illness and disease as the absence of it. The World Health Organization (WHO) concentrates on social and medical wellness. In today’s world of medicine, people still run to the emergency room because they do not have a primary care doctor. Therefore, we as a culture have not adopted in full the ability to practice holistic medicine and prevention vs. treating the illness after it has happened. Holistic medicine is noted to have four components; physical, mental, social and spiritual (DeNisco & Barker, 2013).

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Looking up to a Nurse

Have you ever thought about a nurse that you have worked with and looked up to?  What qualities do you admire?  The nurse that I would look up to would be someone who would be respected and trusted by her peers and her staff.

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In every organization there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion.  Another barrier that is seen in management is the inability to show respect to other team members and allow a learning environment. I agree that it is important for leaders to obtain feedback not only from their staff but from their peers.  The leader must be able to deal with the different personalities of the team that he/she is managing without letting personal feelings get in the way.

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