Summary: Health Care Interactions With Patients

Health Care Interactions with Patients of different Cultures

Culture affects the way health care is provided from religious views to languages spoken. According to recent studies, it has been proven that “Communication problems are among the root causes of 59% of serious adverse events reported to the Joint Commission’s Sentinel Event database“(Wasserman et al., 2014). More and more limited English speaking patients “have been harmed by poor comprehension of their medical condition, treatment plan, discharge instructions, complications and poor or inadequate informed consent“(Wasserman et al., 2014). Therefore, it is important that the medical field finds ways to improve relationships with patients, health care providers, and community members through communication and inter-collaborative practice.

Improving relationships with patients

and healthcare providers is done through professional development.

Peplau’s Phases of Nurse - Client Relationship is one way in which healthcare professionals, can help stop medical errors with limited English speaking patients. Peplau’s Phase is a form of therapeutic relationship in which the following phases work together to improve patient health care relationships. Peplau’s Phases consist of: “Orientation Phase, identification phase, exploitation phase, and resolution phase” (Hood, 2014, p, 90). With the estimated “ 98,000 people per year that die from medical errors”(Wasserman et al., 2014), Peplau’s Phases can provide a way to help this growing issue in the medical profession by correcting the communication, misunderstandings between limited English speaking patients and healthcare providers. In the orientation phase the “elaboration of the client’s needs for assistance” (Hood, 2014, p, 90) is recognized such as the need for greater assistance and attaining the proper help. In phase two identification “Provision of the opportunity for the nurse and the

client to clearly understand each other’s preconceptions and expectations” (Hood, 2014, p, 90). This for example would be when the proper help such as an interpreter arrives for a non-English speaking patient and starts to help with the communication process. While in the third phase exploration occurs when the client and nurse work together to continuously improve the problem. Lastly the fourth phase resolution is when the “opportunity to formulate new goals“(Hood, 2014, p, 90) arises. Meaning the patient fully understands health care goals and treatment or consent is obtained. Therefore, as a result using Peplau’s phases can help in providing a way to eliminate any health care problems that may arise over time such a medical errors which can occur due to lack of understanding due to cultural differences.
As a matter of fact, as culture in the United States continues to grow as well as all over the world, “Transcultural nursing is an essential aspect of healthcare today” (Kanchana & Sangamesh, 2016). However because of the expanding population and different ethnic backgrounds medical errors occur more than one might believe. The following three causes of medical error relate to patients who speak limited English. One error arises because “family members, friends, or non-qualified staff interpreters” (Wasserman et al., 2014) are used to help patients understand medical conditions. This becomes a problem when words are mistranslated or not told to patient due to family concerns and or beliefs. A second way medical errors can occur is when “cultural beliefs and traditions affect care delivery” (Wasserman et al., 2014) and lastly medical errors occur when “providers use basic language skills to get by” (Wasserman et al., 2014), meaning health care providers choose terms that they believe is understood by all, causing harm to patients as well as leading to more misunderstanding when basic language is not understood properly. In healthcare “nurses demonstrate a caring attitude when they take time to understand and appreciate their patients cultural needs and perspectives” (Kanchana & Sangamesh, 2016). Showing that nurses have empathy to the needs of the patient and show cultural competency and “openness to the “patients cultural beliefs, values, and practices” (Kanchana & Sangamesh, 2016). These actions help build a strong nurse patient relationship and uses Peplau’s Phases to provide care that will not cause harm and or misunderstanding in a professional healthcare manner.
Therefore, another model of therapeutic relationship that helps improve this growing issue of medical errors because of lack of understanding due to language deficits is Hames and Joseph which was created in 1980. Hames and Joseph consist of four stages that provide development for medical professionals. Stage one is trust formation. This stage allows for overall patient health care relationship through “honest, respect, positive regards, and empathy” (Hood, 2014, p, 90). The second stage is when the patient starts to show concern and “pulls away from relationship” however the health care provider “continues to show concern” (Hood, 2014, p, 90) by reaching out for help from other trained, professional health care providers. The third stage is the working stage. In this stage “the patient and healthcare provider work together” (Hood, 2014, p, 90) to obtain the set goal, such as understanding the medical condition or the needs of the patient. While lastly the fourth stage is the termination stage, this is during the discharge phase when the nurse and client work together in “engaging in closure activities” (Hood, 2014, p 90). When it comes to transcultural nursing it is important to form a trusting relationship with patients. It is important for health care providers to “develop awareness of beliefs, sensations and thoughts” (Kanchana & Sangamesh, 2016), which helps to form a trusting and understanding relationship. This model gives the overall objective that building a working relationship is key to providing health care because trust from patient to nurse or doctor is a critical aspect of the medical profession.
As a result the growing concern of more and more medical errors occurring in today’s society due to individuals with limited English speaking abilities, is important for healthcare facilities to find ways to better communicate, leading to overcoming medical errors. In the facility in which I work there is a diverse culture of patients. The hospital provides certified interpreters as well as a new computer system called Marty. Marty is a computer that allows for a 24 hour interpreter. The computer system works by skype which is being able to visually see and verbalize with a live individual by computer and have the correct and accurate language when needed to communicate with your patient available at all times. Within my facility I have seen Marty used to verbalize with an exchange student who became ill while studying abroad. This system gave the patient a feeling of comfort as well as his family, to provide a better understanding of his illness and what the healthcare professionals will be doing to provide the best care to the patient. Studies have shown “accesses to professional interpreters is critical for effective communication in the delivery of patient centered and high quality care” (Hadziabdic, Heikkilä, Albin, & Hjelm2011). Therefore the facility I work for has two ways for a patient to receive a proper medical interpretation, both in person by trained interpreters or by Marty an online interpreter that is available for use at all hours of the day. Another way to communicate with patients of limited English speaking is through the technology of using an interpreter phone, this phone is a unit that has two phones built into one system. The patient and nurse both have a phone that connects to an off-site interpreter. The nurse dials into the interpreter and is able to talk to the patient. This communication device allows for easy interpretation between health care provider and patient and provides a safe and effective way to providing health care. In the medical profession, there are many ways to communicate with patients no matter what culture the patient may be. This allows for medical errors to be decreased and patient safety to be increased. “Language greatly affects the ability to understand the role of language and culture in patient safety events” (Wasserman et al., 2014), but with the technology available and the knowledge and skills of professional healthcare providers medical errors can be prevented.
All in all both models Peplau’s and Hames and Joseph shows how health care providers can redirect the way health care is provided by taking the necessary steps to bettering and making the care provided accurate and safe. As a nurse making sure to follow directions and making sure accurate information is provided can help solve many errors in the healthcare profession. As well as showing honesty, respect and empathy to patients. Using professional models to make a difference in the way healthcare is provided can change the way many look at healthcare. Being able to provide safe and effective care should be an essential aspect. Knowledge and skills are necessary to make and reach these goals by stopping medical errors from occurring. Therefore as culture in the nation keeps expanding healthcare providers need to be aware of the needs, beliefs and thoughts of the patients to provide the best care possible.
Accordingly, being a nurse, I have witnessed and came across my own concerns about how to best communicate with a patient whom may not understand the English language as well. Using models as listed above is an easy way to correct that problem and work towards a better outcome of efficient health care. I have taken the time to find resolutions when caring for a patient with a different language by finding information in the hospital’s database in their written language so the patient can read up on the condition in which they are facing. Or I am able to contact interpreters who will come to the unit each time I need a translation for the patient. The concerns of the patient and the well-being of the patient is the main goal as a nurse to prevent medical error from occurring, and create a safe and inviting atmosphere for the patient.
In conclusion ways to build and improve relationships with patients, health care providers, and community members through communication and inter- collaborative practices are all built off of understanding and empathy for one another. In the medical profession, it is easy to be misunderstood with such a fast pace and changing field of study. It is important to make sure all patients and workers fully understand what is occurring whether speaking a different language or understanding a process being new to the health care field. With the “ever-growing number of patients from various cultural backgrounds” (Kanchana & Sangamesh, 2016). Communication is key, and helps in preventing error. “Language greatly affects the ability to understand” (Wasserman et al., 2014) therefore as health care providers it is important to take the time , and effectively look at the patient, the family , and their understanding of the process before making judgments and creating a medical error. Hospitals and healthcare providers work diligently to continuously research and promote healthcare by improving patient safety and proficiency.