Final Exam Global Health

Course 1 = Pulse points 1. To what extent do you believe Mrs. Zahari received effective, safe, and patientcentered care? I do not believe Mrs. Zahari received effective, patient-centered care. The husband to Mrs. Zahari was obviously becoming increasingly impatient, as he should, when he noticed the nurse was ignoring his request for a female nurse. Patient-centered care means to respect and respond to the patient's (Mrs.Zahari) preferences and needs, which almost had to be begged by the nurse from the husband which is not being respectful or giving patientcentered care. 2. In what ways does this case illustrate essentialism and power differences? This case illustrates essentialism by the nurse stereotyping the couple as just "muslims" and not as the individuals that they are. This case illustrates power differences by the husband becoming frustrated when the nurse was ignoring their request of a female nurse to provide care to Mrs. Zahari and appeared to feel powerless when the nurse asked them to please stay as the situation was quite serious. 3. How did bias or stereotyping affect this situation Stereotyping/bias affected this situation by the nurse not recognizing the medicine bundle was part of their culture. The nurse should have been more culturally aware and respectful of the family’s wishes as it was making their family anxious without it. Also, the nurse should have explained why she had to do what she was doing instead of just doing it, assuming the family wouldn’t comprehend the situation. 4. What initial steps should the nurse have taken that could have prevented this situation? The initial steps the nurse should have taken were first a self assessment of their current stance/belief/views on the patient and the family's culture. The next step was to explain why she was doing what she was doing with the hair shaving as the grandmother became very upset after the nurse did that without warning; if she would have explained that ahead of time, there might have been another route they could try or possibly the grandmother would have been less anxious. The third thing would be to allow the medicine bundle to lay with the child as it was not imposing any harm to the child and since it held such significance to the family’s culture. 5. In what ways could cultural competency development models have been used in this situation? One way a model could be used is by looking at the ASKED mnemonic from the CampinhaBacote's model. The nurse could have asked herself these 5 self-questions in the mnemonic to examine her views/biases on the specific culture. The Purnell Model could have also been used in such a way that the nurse could go through the list of different circumstances and how the patient's culture pertains to that area (i.e. family roles, high-risk behaviors, health care practices). 6. Knowing what you now know about becoming culturally self-aware, how would you address issues that may arise when working with a non-compliant patient who has chosen to use herbal medicines instead of his prescribed regimen? The way I would approach this situation is by first examining what I know about the specific culture and the individual views on western medicine vs herbal medicines. Then I would be educated on the uses of the prescribed medications and the importance of adhering to them. If, after my explanations of indications and side effects, the patient still wants to use the herbal medicines, it is my role as the nurse to support and respect the patient's preferences. 7. How does the nurse in this story view illness and disease? The nurse in this story views illness and disease as it can only be cured or treated effectively with western medications and treatments. Although the patient already told the nurse that she doesn’t want to have chemo or the other treatments, the nurse goes on to try to convince the patient that she should agree to treatment. The nurse should understand why the patient is choosing folk healing, try to integrate both their beliefs with the recommended treatment plan and most importantly, respect the patient’s preferences. 8. Thinking about the story and your past experiences, how have you handled a patient who chose nontraditional therapies? What challenges did you face? Thinking back to when I had a patient who chose nontraditional therapies over the recommended ones given to her, it personally was not challenging to accept because I understand that it is the patient’s right to choose what she wants to do. I tried my best to educate the patient fully about the certain treatment plan and even though she has all the information about it, she still chose the nontraditional therapies. It was challenging at first in a way that the patient almost acted as though she did not want to hear about the treatments, however, she allowed me to finish the education and explained her choice and why she made that decision. Her preferences were respected and she was very appreciative of that. 9. How could this situation have been handled differently by the nursing staff if they had practiced patient-centered care? This situation could have been handled differently in such that the nursing staff should have first assessed and asked the patient his reasoning for not wanting the water. If they asked him that, he would have told them about his culture’s views on hot/cold foods/fluids and could have got him an alternative instead. Since patientcentered care was not done, there is now a preventable, unnecessary tension between the nurse and patient/patient family with a lack of rapport since the staff did not take the time to adjust the care to the patient’s culture and needs. 10. Have you ever found yourself in a similar situation? How did you handle it? I have found myself in a similar situation before.It was difficult at first as I did not know how to react when the patient was refusing the certain food we were offering. After talking with the patient, I was able to understand why she didn’t want the pork and what alternatives she really enjoys. I was able to call down to the cafe and request for a different meal that was personalized to the patient. 11. The nurse who was coming on duty based her care decision on her knowledge/perception of Asian cultural behaviors. What are the implications on the patient's care? The nurse coming on duty completely ignored the fact that an assessment/intervention needed to be done for the patient simply because she was of Asian descent. Ignoring the needs of a patient because of their background is not being culturally competent and giving patient-centered care. It is being stereotypical and as a nurse, they should know better. Ignoring the patient’s problems just opens the door to many more potentially harmful problems. 12. What elements of skill-centered approach would you use to provide effective care to Mrs. Lee? One of the elements of skill-centered approach that I would use to provide care to Mrs. Lee would like to practice cultural humility. I would ask genuine open-ended questions and offer active listening to the patient to allow them to convey their feelings and thoughts. I would also use self reflection and educate myself on the patient’s culture and how they may view the delivery and perceptions of health care. 13. How will you use the information you learned in Course I? I will use this information that I learned in Course I throughout my nursing career and in my everyday life. I understand that it is important to be culturally aware and respectful of other beliefs other than my own. It is also important to educate yourself on basic views of other cultures to have an idea of what to expect before the encounter. 14. What information do you think will be most beneficial to pass on to your colleagues? The information that I think will be most beneficial to pass on to my colleagues is to not be stereotypical towards patients. Just because a patient is from a certain religion or culture, does not necessarily mean that they follow the rules and views of that culture. Delivering effective patient-centered care is key to not only building good rapport with the patient, however, you will also meet the patient's individual needs. - Total score for self assessment in module 1.2 = 40 Course 2: Pulse point questions 1. What is the patient's explanatory model in this story as expressed in his words and body language? Mr. Gomez expressed concern over the procedure as he believes that he will not be a man anymore if he gets the procedure done. It is clear he does not have a good understanding of the procedure and the effects it will have on him if he chooses to get it done. After a nurse who spoke his language was able to explain the possible effects it could have and correct some of the beliefs Mr. Gomez had about the procedure, he was more understanding and compliant. 2. If Mr. Gomez was one of your patients, how would you interact with him? What questions would you ask him to learn more about his understanding of his illness? I would first obtain an interpreter to help facilitate the conversation with Mr. Gomez as there seems to be a language barrier. From there, I would assess to see what he knew about the procedure and any concerns he was having about the possible side effects. I would also ask to see what he knows about the cancer and correct any inaccurate information he might have. 3. Which of the three nurse-patient communication models discussed in this module (LEARN, BATHE, or ETHNIC) could have made the interaction with Mrs. Is Tran more effective? I think the ETHNIC nurse-patient communication model would have made the interaction with Mrs. Tran more effective. With this model, it would allow the NP to explore how the patient receives the disease and the reasons why she is choosing to use nontraditional treatments. Using this model could have avoided the anxiety and worry that was brought upon Mrs. Tran when the NP brought up going to the hospital and questioning her actions. 4. What are the benefits of using the model that you selected for both the patient and the nurse? As stated above, the ETHNIC model would benefit both the patient and the NP by avoiding misunderstanding and promoting exploration through assessment questions. This model would give the NP more of an understanding of the patient’s view of the situation and possibly answer personal questions she might have had about why the patient is choosing these treatment options. For the patient, it allows her to express her feelings and perception of her disease process which promotes a healthy nurse-patient relationship and will help with possible medication/treatment compliance because the patient feels as though she is being heard. 5. What language signage might have helped the patient receive more timely care? I think either the video remote or telephone interpreter would have been beneficial in this situation. I chose these because there might not be a person on site at the time who could translate for the patient and if there was, it might take time to track them down and then walk to where the patient was. Also, I feel it might be faster to pull up a video or call the language line and contact someone instantly to assist the patient as soon as possible to help get him to the right place. 6. At what points in the case would the patient have benefited from an interpreter? The patient would have benefited from an interpreter or instructions in his language when the internist gave him instructions/directions to go to the hospital. The second time he could have used an interpreter would have been when he arrived at the registration clerk. The other point an interpreter would have been beneficial was when he was given instructions by the x-ray tech. 7. How could having a professional interpreter available have helped in the situation? If a professional interpreter was used in this situation, it would have helped immensely. The interpreter would have correctly and truthfully told the patient what the procedure was for and what would be removed. With that information, the patient would have been able to confidently state whether or not she would want the procedure done. 8. What are some of the consequences of using a child interpreter in these kinds of situations? A consequence of using a child interpreter in these kinds of situations is that all the medical information might not be translated fully to the patient. Another consequence would be that, just like this situation, their culture might affect what information is actually communicated to one another, leaving room for error. Having a child as an interpreter might also add pressure and awkwardness to the relationship of the child and the patient, as well. 9. What risks would the patient and providers face if an interpreter was not used to facilitate communication in this scenario? The risks that the patient would have if an interpreter wasn't used would be inaccurate information given to the patient and even possibly death if complications continue. The risks that the providers would face would have been being sued for not using the interpreter line which was available for the access. The risks to the patient would increase pretty fast if the interpreter services were delayed any longer. 10. Can you think of a situation in your practice where involving an interpreter could have improved communication and understanding? How would you have integrated an interpreter to deal with the situation? Yes, I can think of a time when the use of an interpreter would have helped a situation immensely. He was from Russia and spoke very little English, an interpreter was finally offered to him but it has been some time since admission that it was offered to him. If I was the nurse, I would of have reached out to the interpreter services on admission when I realized there was a communication barrier 11. In the vignette, how should the interaction between the provider, patient and interpreter have gone? The nurse should have put the interpreter on speaker so that the nurse could speak to the patient directly with the interpreter translating for the patient. Also, at the end. The nurse should have also waited to speak to the patient until the patient and her husband were finished speaking. All of these things could have aided in a smoother interaction. 12. What similar experience(s) have you seen or heard of in your organization? One situation similar to this is when a patient came into hospital and waited in the ER just to get a flu shot. There was also a language barrier and an interpreter had to be used to tell her that she can go to the HCP for this or even the local pharmacy. She was relieved of this information and wished she knew this information before waiting for the amount of time she had when it wasn’t an emergency situation. 13. How could this situation have been prevented? This situation could have been prevented by his HCP providing the accurate information about where to obtain the refills. Also, the clerk at the front desk of the ER could have obtained an interpreter when assessing what was wrong with the patient since she has to put it in the system. If it wasn’t caught at that point then the ER nurse could have come out soon after that to tell him this information. 14. How effectively did the nurse assess the patient's health literacy? The nurse did not effectively assess the patient's health literacy. Every time the nurse would ask the patient a question, it was clear the patient was not in the right mind set. The nurse then continues to ask these medication questions and goes in her purse, which the patient agreed to but is only alert to herself so the nurse should have ended the questions earlier and reassess at a later time when the patient is AOx3. 15. What would the nurse have done differently if she had taken the patient's health literacy into account when providing care? As stated in the previous question, the nurse should have paused the medication assessment questions. It was obvious that the patient was not in the mind to answer the questions the nurse was asking. Also, the nurse should ask one question at a time, asking multiple questions can be confusing to the patient. 16. What are some of the potential problems the patient could encounter because she does not understand the medication, its appropriate use, or possible side effects? The patient could take the medication more often than she is supposed to or more tablets than prescribed. Depending on the medication, she could take certain foods or drinks that are not allowed with certain medications, increasing risk for adverse effects. Since the patient isn’t aware of the side effects, they could arise and cause the patient more anxiety and fear, potentially leading to more problems. 17. How could appropriately translated patient education materials on pregnancy, depression, and medication have helped this situation? These materials could have potentially prevented serious adverse and side effects that the patient is at risk for experiencing. These materials could also cut down on mistrust the patient may develop in the HCP and nursing staff because it shows patient-centered care. The patient would experience a more enjoyable life if this information was given to her properly 18. How will you use the information you learned in Course II? I will use this information by applying it to my everyday life, inside and outside of work. It is important to assess the patient’s health literacy and any barriers to communication before asking questions and giving information. Gathering the materials in the appropriate language of the patient and obtaining an interpreter when needed is good practice to follow. 19. What information do you think will be most beneficial to pass on to your colleagues? The information that I would pass on to my colleagues that I think is important is to assess for any barriers to communication in your patient. If you note any, obtain the proper interpreter (various ways) before continuing the conversation. When using the interpreter, make sure you’re speaking directly to the patient, not the translator. Course 3 Pulse point questions 1. How can research contribute to your cultural and linguistic competency advocacy? Research can contribute to my cultural and linguistic competency advocacy by providing a variety of information that could be missed if the research was not done. Research can consist of many different forms and with this, an enormous insight on patient views and perceptions that would otherwise be overlooked. With these findings, the health care system can change or adapt its ways to make it more conducive to the patients and their needs. 2. What skills do you need to develop to be a successful advocate for cultural and linguistic competency? The skills that you need to develop to be a successful advocate for cultural and linguistic competency are a variety of skills. Some of these include patience, self reflection and the willingness to learn and shape one’s previous bias and views to be open minded and welcoming to all people of all cultures. These are just a few skills that one should develop inorder to be a successful advocate for cultural competency. 3. What next steps would you like to see implemented by the nurse manager to begin making improvements on her unit towards the delivery of culturally and linguistically competent care? I would like to see nurses give educational materials and instructions to patients in their main language. I would also like to see interpreter services used more often to enhance patient education. I would also like to see less stereotypes and bias about certain cultures since that interferes with patient care and education. 4. How could the results of this unit's organizational assessment be used by other departments within the hospital? The results of this unit's assessment can be used by other departments by the other areas adopting the same or similar assessment strategies. Not just one area or unit of the hospital can benefit from this, every area can make these changes and it will enhance patient care. It will also build patient rapport and trust among providers which will also increase patient care and safety. 5. What types of similar initiatives, if any, does your organization have in place to better serve minority patients? My organization that I work for has interpreter services in the case the patient does not speak english. I am not familiar with any other services in places to serve minority patients. This question prompts me to ask for information about this and any resources that are offered in the case I need to offer them to a patient. 6. What kinds of cultural and linguistic competency initiatives could be implemented at your place of work that would help serve your patient populations? How could these help improve patients' satisfaction? At my place of work, we could have more educational classes or relias about cultural competency and different minority groups to help enhance our knowledge. Having this knowledge could greatly improve patient satisfaction and comfort in care that we provide. We are a home health agency where going into patient houses is a necessity, so being culturally competent and aware of certain culture norms before entering the home would be very beneficial. 7. What type of mechanism(s) does your organization have to collect data regarding risk factors for patients and families? At my place of work, the admissions nurse is the one who collects this information. They use the assessment template on our database to ask admission questions which include comorbidities that the patient has. On that form there is a section for patient history and family history if the patient knows this information. 8. What data collection activities have you been involved in regarding your patient populations and the diseases/conditions that are prevalent in the community? Since I am not an admission nurse, I don’t participate in many disease/condition collection at my work. Even though this is not my role, I still collect vital information about my patient and sometimes it is a bit of history about themselves that was not written in the database already. If this occurs, I add it to their profile and continue to look for other problems that they might be experiencing or at risk for and educate the patient as I see fit using nursing judgment. 9. How could the nursing student have asked the mother about the contents of the bottle in a culturally sensitive manner? The nursing student could have ask the mother about the content in the bottle a couple of different ways. One way is by stating “I see the milk you are feeding your child is different from what I’ve seen before, could you tell more about that?”. Another way would be to politely ask how the milk was made or to show you the ingredients she used to make it. 10. What similar situations have you experienced or observed where an incorrect assumption or judgment was made about a patient? I unforentually have witnessed situations like this before, at work and outside of work. One time was when an asian woman was sitting in the hospital bed when the doctor came in to discuss her health and his findings. As he was talking with her, he was noticeably loud and exacerbating his words as if she was not fluent in English. She grew up in the town of the hospital and came to America when she was young, growing up in a household that spoke both English and her native language. I could see the frustration and hurt on her face as the doctor was talking to her and the embarrassment on the doctor's face when the patient responded and, to his surprise, spoke perfect English. 11. Open-mindedness and respect for all patients. The nurse did not question or shut down the patient when she talked about her spirituality. The nurse asked the appropriate questions about the medications and did not push the patient to do something that she would be uncomfortable doing. She remained open-minded throughout her conversation with the patient. 12. Communication tools and strategies for eliciting patients' social, family, and medical histories, as well as their health beliefs, practices, and explanatory model. The nurse did explore to see how the patient was feeling and if it was any different then at home. The nurse could have offered spiritual services to the patient since she mentioned her beliefs often and relied heavily on a higher power. Doing so might help the patient adhere to her medications better and have a different outlook on her life. 13. Framework for exploring the family structure and dynamics, health beliefs, behaviors, and health practices demonstrated in different cultures and population groups. The nurse did show patience and active listening when the patient was speaking about her feelings. She did not appear to be judgmental when the patient talked about her religion. She also reassured the patient that care would still be provided to her even though the patient said she was okay without it. 14. How could the partnership between the school, tribe, and community clinic help address diabetes for Rob Ocuca? It could help bring attention to the diet that Rob might be used to and open suggestions for modifications to help with weight loss and glucose control. Bringing awareness to his culture could help resolve the bullying. It may also help increase Rob's self esteem and confidence in himself which in turn might encourage him to take better care of his health. 15. What types of community partnerships can be established by your organization to meet the needs of your patients? There are many community partnerships out there that can be established by my work to meet the needs of our patients. To find these partnerships, thorough assessments and questionnaires would have to be performed in order to find the right partnerships. In doing this, I think it would increase patient satisfaction and overall moral since it would involve bringing awareness to many different cultures. 16. How will you use the information you learned in Course III? I will use this information that I learned in this course and implement it to the best of my abilities in my work life. I will make recommendations to my supervisors and colleagues about the importance of community outreach. I will also do my own research on my patients and the different cultures that I come across to gain knowledge and cultural competency 17. What information do you think will be most beneficial to pass on to your colleagues? The information that I found to be most beneficial was education and community outreach. Educating yourself about other cultures and using the available resources that are out there can really enhance patient satisfaction. It is also a good skill to have and to be able to do this in every situation and opportunity when it arises because that is part of being a nurse.