Address language and cultural diversity or risk miscommunication, poor care
Address language and cultural diversity or risk miscommunication, poor care
The Chinese man struggled to understand what his American health care provider was saying. The patient barely spoke English. The provider threw up his hands in frustration and sitalicsid, "He just doesn't get it."
"Some people assume they have a low IQ because they can't comprehend [English]," says Angel Andrés Ham, MD, an anesthesiologist affiliated with Memorial Hermann Southwest Hospital in Houston, TX. The incident above happened to Ham's grandfather, who was a professor and the writer of college textbooks and for whom English was a second language. Just because some patients struggle with English doesn't mean they're unintelligent, Ham says. "It's really important to recognize that fact," he says.
Ham is Asian, but he was born in Honduras and trained at a Western hospital system. This background has given him a unique perspective on cultural differences. Language and cultural differences often are at the heart of miscommunication between patients and providers, according to sources interviewed by Same-Day Surgery. Such miscommunication has the potential to result in poor, or even harmful, patient care. The potential for miscommunication has taken on even greater meaning for hospitals due to patient-centered communication standards from The Joint Commission that will be effective Jan. 1, 2011; however, findings will not affect a hospital's accreditation decision any earlier than January 2012.
Speaking a little bit of a patient's language goes a long way toward helping that patient relax, says Ham, who speaks Spanish and a little Chinese. "The patient can identify with you," he says. "When you can understand their culture, you are apt to get a more accurate history."
When you don't understand their language, patients are more guarded and often more anxious, says Janet Ruscoe, RN, director of surgical services at Mercy Medical Center in Merced, CA.
At Elmhust (NY) Hospital Center, most residents (56%) in the neighborhoods around the hospital were born in another country and speak another language. To address this issue, the hospital printed cards with the heading "I speak" and a list of several languages. The cards are distributed to patients, who can point to one of the languages when interacting with staff. "It will identify for us what language they're speaking," says Anne McGann, RN, MS, CNOR, supervisor of nursing.
At Elmhust, many staff members were born and trained in another culture and are familiar with medical terminology in other languages, McGann says. These staff members make preoperative telephone calls to patients from other cultures, she says.
On the day of surgery, it's imperative that patients understand the important information that anesthesiologists and surgeons are giving them, she emphasizes. For example, patients need to understand the expected outcome, McGann says. When needed, staff arrange for interpreters, she says. "Being able to reassure them and speak to them is absolutely a necessity," McGann says.
Mercy Medical uses CyraCom. The service provides blue telephones with two handpieces. The simple service requires that a provider plug in the phone, dial a number, enter an account PIN number, and notify the service of the language needed. "Within a few minutes, there is a certified translator with that patient with their native language," Ruscoe says. The staff member enters a number for the certified translator in the patient's record, she says. The hospital is billed in time increments. (See interpretive services and resources, below.)
The service is used frequently, particularly in the preadmitting office where staff members don't know when physicians will send patients for preadmission services. "They just come in the door," Ruscoe says. "To be efficient, we have to be able to get someone on the line quickly."
In addition to translation services, Memorial Hermann Southwest also has full-time Vietnamese and Chinese translators, Ham says. Those translators were added when an Asian wing was added to the hospital. That wing is decorated in a spartan manner, to reflect Asian influences, and serves Vietnamese and Chinese comfort food, he says.
Mercy Medical Center also uses live translators, both in house and contracted, primarily on the day of surgery, Ruscoe says. Live translators have shown useful for physicians who are updating their history & physical and marking the surgical site, she says. Also, physicians often use them after the case to speak with family members, Ruscoe says.
Keep in mind that interacting with persons from another culture involves more than just language, Ham says. "Learn how members of that particular culture communicate with each other, "he says. "Tone of voice, eye contact, physical contact those are important."
For example, Asian patients often won't make eye contact, he says. "People wonder, what are you trying to hide?" Ham says. "But it's a sign of respect." (See more tips for providing care for persons from other ethnic groups, below.)
Don't forget written materials
Having written materials, including signs and patient handouts, in other languages is helpful, sources say.
Elmhurt provides written instructions in about eight languages, McGann says. The hospital developed the handouts in-house, she says. "We have signs also in English and Spanish and some Chinese," McGann says.
Staff at Mercy Medical Center call in patients' postoperative prescription and notify pharmacies if patients need instructions in Spanish, Ruscoe says.
"Respect and understanding for cultural diversity helps you to provide customized care to your patient," she says. "Yes, they are here for surgery, but you have to treat whole patient. The more you understand about who you're taking care of, the better job you can do taking care of them." (See story on impact culture has on care, below.)
Resources
For information on translations services, contact:
- Communication Axess Ability Group (sign language), Houston. Phone: (713) 807.1176 E-mail: [email protected]. Web: www.caag4.com.
- CyraCom, Tucson, AZ. Phone: (800) 713-4950. E-mail: [email protected]. Web: http://cyracom.com.
- Language Line Services, Monterey, CA. Phone: (800) 752-6096 Option 2. E-mail: [email protected]. Web: http://languageline.com.
- MasterWord Services, Houston, TX. Phone: (866) 716-4999. Web: http://www.masterword.com. E-mail: [email protected].
The National Board of Certification for Medical Interpreters has a National Registry of Certified Medical Interpreters, which serves as a central online resource to verify credentials and to find qualified interpreters throughout the country. The registry can be searched by interpreter name, city, state, language, or other categories. There is no fee to access the registry. To view the registry, go to http://www.certifiedmedicalinterpreters.org.
The Joint Commission's monograph, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals includes example practices, information on laws and regulations, and links to supplemental information, model policies, and educational tools. It can be downloaded for free at http://www.jointcommission.org/PatientSafety/HLC.
Culture impacts patient experience Influences includes pain, family visits Many areas of patient care are influenced by a patient's culture, including their religious perspective, expressions of pain, and even how many family members they bring to surgery. Religion plays an important role in many cultures, says Angel Andrés Ham, MD, an anesthesiologist affiliated with Memorial Hermann Southwest Hospital in Houston, TX. He points to Jehovah's Witnesses, who don't accept blood transfusions. Culture also can influence how pain is expressed, Ham says. Many Asians are stoic, he says. "They can be hurting, but they won't say anything," Ham says. If Asian patients are grimacing, it might mean they are in severe pain, he says. In comparison, many Hispanics are very expressive, he says. If some of them feel any amount of pain, they might express it exponentially, Ham says. "It's very culturally dependent," he says. In some cultures, family involvement in a patient's surgery is important, says Janet Ruscoe, RN, director of surgical services at Mercy Medical Center in Merced, CA. Even for outpatient surgery, some patients might have as many as 10 family members there, Ruscoe says. "In preadmitting, we may explain that not everyone can come in [and see the patient], but we try our best to accommodate them," she says. When dealing with large families, identify one contact person, she suggests. Explain that there is a waiting room and, if applicable, a cafeteria available, Ruscoe advises. When the patient is in recovery, staff can "trade out" one family member for another so they can take turns visiting, Ruscoe says. "We work with them," she says. |
Be sensitive to cultural norms The physician went to meet his patient, who was Muslim. He extended his hand to the male patient, and then extended his hand to the patient's mother. "She exploded and said, `I can't touch another man except my husband,'" says Angel Andrés Ham, MD, an anesthesiologist affiliated with Memorial Hermann Southwest Hospital in Houston. The physician was shocked, Ham says. However, he learned a lesson: Be alert to how you approach female Muslims who might be wearing traditional garments and/or covering their faces, Ham says. Many cultures carry distinct practices or beliefs, and if providers are unfamiliar with them, they might inadvertently insult a patient or family member, he warns. Consider these examples:
|
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.