Advanced Effective Communication, Cultural Competence, and ...
Advanced Effective Communication, Cultural Competence, and ...
Advanced Effective Communication, Cultural Competence, and ...
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A Roadmap for Hospitals<br />
Chapter Two: Assessment<br />
• Make sure the patient has been assigned to a room that<br />
can accommodate his or her mobility needs.<br />
• Make sure any mobility aid the patient uses (such as a<br />
service animal, cane, or walker) is readily accessible to<br />
the patient.<br />
• Determine whether the patient requires<br />
accommodations (such as adaptive switches or an<br />
intercom call system) to access the nurse call system.<br />
• Note the need for mobility assistance in the medical<br />
record <strong>and</strong> communicate these needs to staff.<br />
• Make sure appropriate precautions are in place to<br />
prevent falls. Some hospitals post a sign above the<br />
patient’s bed or door, or use special colored socks or<br />
bracelets to identify a patient at risk for falls.<br />
❑ Identify patient cultural, religious, or<br />
spiritual beliefs <strong>and</strong> practices that<br />
influence care.<br />
<strong>Cultural</strong>, religious, or spiritual beliefs can affect a patient’s<br />
or family’s perception of illness <strong>and</strong> how they approach<br />
treatment. In addition, patients may have unique needs<br />
associated with their cultural, religious, or spiritual beliefs<br />
that staff should acknowledge <strong>and</strong> address.<br />
• Ask the patient if there are any cultural, religious, or<br />
spiritual beliefs or practices that may influence his or<br />
her care.<br />
• Ask the patient if the hospital environment is<br />
welcoming to their cultural <strong>and</strong> religious or spiritual<br />
beliefs. Some religious-based hospitals display items in<br />
patient rooms that reflect the organization’s religious<br />
tradition <strong>and</strong> may conflict with the culture, religion,<br />
or spirituality of the patient <strong>and</strong> family. Consider<br />
removing the items, if possible, or covering them when<br />
necessary.<br />
• Respect the patient’s needs <strong>and</strong> preferences for<br />
modesty by assigning appropriate providers,<br />
uncovering only the parts of the body necessary for<br />
examination <strong>and</strong> treatment, providing privacy in<br />
toileting <strong>and</strong> washing, <strong>and</strong> using full gowns or robes<br />
for walking <strong>and</strong> transport. Many cultures <strong>and</strong> religions<br />
have restrictions on touching, distance, <strong>and</strong> modesty,<br />
which may be affected by providers of the opposite sex<br />
or staff that are younger or older than the patient.<br />
• Determine if the patient uses any complementary or<br />
alternative medicine or practices. Consider<br />
Helpful Tip: Underst<strong>and</strong>ing the<br />
Patient’s Perspective<br />
Arthur Kleinman developed a clinical model aimed at<br />
creating a shared underst<strong>and</strong>ing between patient <strong>and</strong><br />
provider. The model maintains that caregivers can identify<br />
cultural- or religion-based beliefs <strong>and</strong> practices by asking<br />
questions about the patient’s perspective of his or her<br />
illness <strong>and</strong> use the answers to create a treatment plan. The<br />
model includes the following types of questions:<br />
• What do you think has caused your problem?<br />
• Why do you think it started when it did?<br />
• What do you think your sickness does to you? How<br />
does it work?<br />
• How severe is your sickness? Will it have a short or<br />
long course?<br />
• What kind of treatment do you think you should receive?<br />
• What are the most important results you hope to receive<br />
from this treatment?<br />
• What are the chief problems your sickness has<br />
caused for you?<br />
• What do you fear most about your sickness?<br />
Reference: Kleinman A., Eisenberg L., Goode B.: Culture,<br />
illness <strong>and</strong> care: Clinical lessons from anthropologic <strong>and</strong><br />
cross cultural research. Ann Intern Med 88(2): 251–258,<br />
Feb. 1978.<br />
incorporating these into the patient’s care, if<br />
appropriate.<br />
• Consult a professional chaplain, if available, to<br />
complete a spiritual assessment. The chaplain may<br />
have screening questions to identify religious practices,<br />
relaxation techniques, <strong>and</strong> other coping resources that<br />
may influence care.<br />
• Provide an area or space to accommodate the patient’s<br />
need to pray. In addition, ask the patient if there are<br />
specific times of day to avoid scheduling tests or<br />
procedures in order to respect the patient’s religious or<br />
spiritual practices.<br />
• Note any cultural, religious, or spiritual needs that<br />
influence care in the medical record <strong>and</strong> communicate<br />
these preferences to staff.<br />
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