Role of cultural competency when delivering healthcare to geriatric population
According to Moon, (1999) “Reflection is really a process that begins with looking back on a situation, pondering over it, learning from it and then using the new knowledge to help you in future similar situations. Reflection, which is learning through experience, is not a new concept. As humans, we naturally reflect on our surroundings and experiences”.
The primary purpose of this essay is to conduct a reflective study on some of the role of cultural competency when delivering healthcare to geriatric population. As determined, this reflective study will improve the desired levels of practice and understanding within my course module and period of learning that is primarily based on the experiences acquired on the field. In this case, I choose to conduct a reflective study as described by Gibbs (1988) model that encourages a healthcare practitioner to think in a systematic way about the processes and the phases of experience that should be used to structure a reflection. Gibbs provides a well-structured approach that I will use in conducting this reflective study, a factor that is significant in healthcare sector.
Tasks, Skill or Competency Performed: Communication skills and cultural competence
This week I interacted with a Hispanic patient. P.D is a construction worker who was repairing a shelf in his garage when he lost his balance and fell from the ladder. This elderly man was brought to the emergency room by his wife and son. The patient had a history of myocardial infarctions (MI). From the current clinical presentations, it was likely that Mr. P.D. was having another MI.
In this case, I applied the Gibb’s model to explore the situation. According to this model, the first step is description/assessment- which is a crucial aspect of nursing process. During the assessment, Mr. P.D complained that he had been experiencing dizziness and headaches in the last two days. I assessed the patient feelings by encouraging him to talk about his thoughts and what he had been feeling at this stage. Although I avoided commenting, I realised that the patient was sad that he was having a nurse student to care for him. He was disrespectful to me on several occasions and he was extremely demanding. He kept on saying that he did not need my help because he had made peace with God and was ready to die. I have never had a patient reject my help and this situation was becoming frustrating. I almost lost my patience and composure. My supervisor kept on encouraging me to press on as nursing best practices are attained through hard experiences (Care Quality Commission, 2009).
Role of cultural competency when delivering healthcare to geriatric population
My supervisor and emergency room physician ordered for intravenous fluids of dopamine infusion, and Foley catheter. His condition improved and was admitted in the facility for two days to monitor his condition. I was asked to educate him and his family on the evidence based self management practices. This was the most challenging part because the patient was not cooperative. I understood his behaviour as most geriatric patients and their families are often subjected to stresses, especially when their loved ones are diagnosed with life threatening conditions (Moore, 2013).
Reflective evaluation is the third step of Gibbs model. Therefore, I looked objectively at what was positive in this situation, what was well and what was negative. From the evaluation process, I realised that P.D felt that I was not qualified adequate help. Secondly, he was anxious that if he is admitted, he would die away from his ancestral home, which is a taboo according to their cultural beliefs. He had cardiovascular health needs prior to this, but according to his wife, he likes doing things for himself. On the other hand, his wife seemed very concerned about her husband’s health and safety and wanted him to stay in the hospital as long as necessary (Naidoo & Wills, 2003)
Clearly, this was a dilemma. However, I recalled that to interact and effectively with the patients and their care givers, I had to implement the necessary skills. In this case, I needed to be an active listener and great concentration. This is achieved by observing the patient’s body language. This is important because it is through this body language that I realized that the patient was not happy with me. I managed to win his trust by holding an open discussion and offering of encouraging gestures. Using the Health belief model, I managed to get patient cues and real concerns, acknowledge their problems and enabled me to follow them up (Department of Health, 2010).
Role of cultural competency when delivering healthcare to geriatric population
From this experience, I have learnt that using good communication skills, nurses have the ability to explore the patient’s feelings and worries; which helps them identify the effective interventions that can be used to cope with the patient’s emotional suffering. I also learnt that patients needs and preferences vary, and often what a patient really wants is to be heard. Through this session, I have learnt on how to address each situation and the appropriate measures to undertake if confronted with difficult communication issues (Care Quality Commission, 2009).
At the end of the week, I was able to collect patient’s information systematically, able to solve problems using the weaknesses and opportunities identified. In addition, this practice improved my clinical decision making processes. From this practice, I have become more informed and inquisitive. In addition, I have developed a well nurtured communication and interaction skill that is blended with elements of confidence and assertiveness, and innovativeness. I have gained much more knowledge and understanding on health disorders that affects the geriatric populations (Fleming et al. 2015).
Role of cultural competency when delivering healthcare to geriatric population
This particular week in the course module, I have established my Strength, Weakness, Opportunities and Threats SWOT analysis and communication skills which is essential to employers. The ability to confidently and clearly express ideas and speech, Collect information systematically, able to solve problems using initiative and identify opportunities & proactive in putting forward ideas &solutions. I have always thought that I have a well nurtured leadership skill that is blended with good communication skills both written and oral with the elements of confidence and assertiveness, including creative part of what defines my commitment; but after this topic learnt in class, I realised that more knowledge and understanding is required in order to make appropriate clinical decisions. This clearly determine the need to be morecritical with my assignments, a move that would require me shift from the descriptive approach in writing to a more critical and analytical approach. In addition, I need to be inquisitive, informed and aggressive throughout the work placement period in order to spur my knowledge.
Some of the tasks, I was involved to do this week include the provision of high standards of care to the elderly service users’s within the Amber Home Carers I was deployed to conduct my internship. This included assisting in the development of care plan, initiation of a patient’s assessment and monitoring approach of patient who have scored high fall-risk(Care Quality Commission, 2009).I used my module to reflect and learnt some of our client’s strengths and needs during the process of care. From this exercise, I have learnt that an effective care approach is one that integrates cultural competence and one that respects the patient diversity and unique values and beliefs. I have observed that this approach promotes quick recovery by increasing patient’s satisfaction as their individual specific needs are met.
Lesson learnt at the end of the week: The role of cultural competence in delivery of care
From this practice, I have learnt that lack of cultural competence during care delivery greatly increases the patient’s stress, which results to inadequate care. For example, my patient believed that during dyspnea period, the physical energy was becoming depleted. He was rebellious because he believed that uninterrupted rest, eating food made of herbs and adequate sleep would help his body to recharge. The lack of cultural awareness made the patient to become more aggressive and stressed. For instance, the patient said “I want to eat wife food”. I understood that he wanted his wife to feed him. This made the patient even more uncomfortable and anxious because he actually meant that he wants to eat his favourite meals prepared by his wife. When he tried to make relax, he would listen none of it. The reason being that he wanted home food cooked with herbs that will send the evil spirits away. Only his wife knew how to prepare the food. The patient did not eat any food until I organized with my supervisor and nurse manager to request his wife to bring him some food. I did not associate cultural awareness with increased patient dissatisfaction (Santy & Smith, 2007).
Role of cultural competency when delivering healthcare to geriatric population
Fortunately, during the week, I was informed by my supervisor that there would be a cultural awareness training module that would run for two days. From the experience with the patient, I knew how important and beneficial the module would be towards work placement roles and responsibilities and in the acquisition of my career goals. Through the module, I was able to learn the various ways to assess patient’s cultural needs and strengths which is an integral element during delivery of quality care (Department of Health, 2010). I learnt that cultural competence is very as it helps the nurses develop an individualised treatment approach that addresses patient specific needs.
Through the training, I also learnt that the element of diversity has the capacity to bring richness of knowledge, experience and understanding between my peers, lecturer and the clients, a factor that develops mutual acceptance and respect (Jenny, 1999; Hull, Redfern Shuttleworth 2005). The inclusion of diversity during care therefore enables one to develop mutual views including the consideration of alternative values. Therefore, I will incorporate the aspect of respect to diversity including non-judgmental, open mindedness and positive regards enhanced the relationship all healthcare stakeholder (Jasper, 2003).
The training has equipped me with an understanding of the diverse healthcare environment, which improved my interaction with the patients and colleagues at my work placement. Different cultures at work place incorporate different experiences and skills. It is therefore significant to consider the fact that diversity remains an essential element to service user (Santy & Smith 2007).
Role of cultural competency when delivering healthcare to geriatric population
In addition, I was able to identify the needs and strengths of the service users which is an integral element in clinical practice (Department of Health 2010). I have learnt that this cultural competence is essential as it helps the patients to remain focused and adaptable, thereby establishing a healing environment which I had no knowledge of previously. By interacting with the geriatric population, I have discovered that the element of diversity has the capacity to bring richness of knowledge, experience and understanding between the healthcare stakeholders, a factor that develops mutual acceptance and respect (Hull, Redfern Shuttleworth 2005). The inclusion of diversity during care therefore enables me to grow and develop mutual views including the consideration of alternative values.
What Can You Do Now That You Couldn’t Do: Integrate the components of cultural competence into practice
Campinha- Bacote and colleagues describes the components for cultural competence in healthcare. These includes cultural ; a) knowledge, b) awareness, c) skills, d) encounter and e) desire. Cultural awareness refers to self-examination as well as in-depth exploration of an individual cultural as well as professional background. I am able to explore my own cultural healthcare values and beliefs. This is because understanding another person’s does not guarantee that one will become cultural competent. I am now able to use the cultural awareness assessment to assess my personal level of cultural awareness, and to get an insight on the understanding of my cultural values and beliefs (Long, 2016).
Role of cultural competency when delivering healthcare to geriatric population
Cultural knowledge is the second component of cultural competence. This entails obtaining of information based on the different ethnic groups and cultural. I am now able to read widely including journals, textbooks and attending workshop presentations which will help me understand different traditions and cultural beliefs (Jackson and Thurgate, 2011).
The third component is the cultural skills which entails the ability to gather relevant cultural data regarding patient s clinical presentation. Several frameworks have been established in for assessing the ethnic and racial differences observed in patients. The model provides a systematic approach for approaching ethnically diverse population. I am now able to use the Giger and Davidhizar model to assess the patient social organization, environmental control, communication as well as the biological variations (Henwood, 2006).
The fourth component of cultural competence is the cultural encounter. This refers to all activities that help the nurses to encounter with the patients from diverse cultural backgrounds. I have learnt that developing cultural competence is a continuous process that continues throughout the nurse’s career. The last component is cultural desire. The diversity in healthcare training has aroused intrinsic motivation to remain open to other people, respect the diverse cultural differences and to become willing to learn from the people I interact with. Therefore, I will incorporate the skills and knowledge to become a agent of change and to create awareness on factors that affects the perceptions and attitudes of my group members with regards to competency that relates to diversity (Campinha-Bacote, 2013).
List some aspects of your work that you felt you did well.
The work placement programme provides extensive insights into the real world of healthcare. The best way to gain a meaningful understanding of healthcare practices, it is important to work alongside experienced professional and to observe them as they go about their daily tasks (Owen and Leva, 2009; Duke, Connor, & Mceldowney, 2012). This greatly strengthened my skills and competences. During this one week placement, I learnt few strategies of administrative works including file management, management of nurse shift schedule and contacting of clients. I have also learnt ways to manage compute filling system, doing basic research and editing. I enjoyed performing these activities. Some of the aspects I feel that they went well includes;
- Good interaction with my supervisors and senior
- Making new friends and learning about their culture
- Incorporating cultural competence when performing my tasks
- Developing of individualised healthcare plans
- Establishing skills required to develop therapeutic relationships
- Communicate effectively using verbal and non verbal therapeutic methods of communication.
What made these things go well?
These things went well because I have adopted desirable behaviors that facilitate effective communication. For example, when interacting with geriatric patients, I actively listened and watched with great concentration. This helped me identify cues that concerned the patients, and to acknowledge their challenges as well as establishing strategies to follow them up. In addition, I would reflect back o the issues, which helped me expand on the potential concerns and problems. I also sought clarification whenever I was confronted with contradicting information. In addition, I would question to seek clarification of discrepancies (Gustafson & Reitmanova, 2012).
In addition, I incorporated theoretical knowledge and skills in the work placement which helped me meet the organizations standard of practice. These factors also facilitated my understanding of healthcare environment and in developing effective approaches that would enable meet patients demands effectively (Owen, 2009). The training on cultural competence and embracing diversity that was organized by the organization also impacted on achieving these goals. This is because it established a cohesive patient-healthcare provider’s relationship that helped me to understand their needs and to develop effective holistic care strategies (Moore, 2013).
List some aspects of your work that did not go so well.
I did not know what to expect when I enrolled to work with the patients. In the first days, I had the tendency of normalizing patients. For example, I would use statements such everyone gets pain after such operations. Later, my supervisor told me that generalizing such statements belittles the geriatric patients as it moves the focus away from them (Naidoo & Wills, 2003). In addition, my supervisor also warned me that I was using false reassurance. For instance, I would assure the patient that everything will be fine after having these injections. Although this made the patient feel better, my supervisor cautioned that such reassurances can be distressing if the results are not fine. I also intended to use multiple leading questions. My supervisor said that it might raise a wrong alarm that I am not interested in the patient’s answers (Duke, Connor, & Mceldowney, 2012).
Working with a geriatric patient who believes in traditional medicine and spiritual beliefs was made me more confused. Although I have learnt about cultural competence before, I had little idea on how to care for this patient, or even to counsel him on nutritional and behavioural advices. I felt I could not gain much from them due to language barriers. I paid little attention to their opinion or their contributions which made the patient become dissatisfied. Like most of the nurse students, I totally ignored the integration of the aspects of diversity as I had a preformed mind that assessing the cultural needs of each client before establishing appropriate care plan is challenging (Jackson &Thurgate, 2011). However, I have come to realization that the integration of cultural competence in nurse practice is an effective approach as it strengthens communication between the team members. I will make it a practice to discuss matters of cultural competence with other colleagues in my future nurse practice.
How would you behave differently if the situation arose again?
During this one week of training. I have learnt that cultural competence promotes the four principles of nursing practice. These included autonomy, malficence, beneficence, and justice. If a nurse is culturally competence, she or he will ensure that the patients preferences are respected protected from harm, and restoration of patients health using the resources available equitably and without any discrimination (Hull, Redfern, and Shuttleworth, 2005). These situation or even harder situations are bound to happen. Therefore, it is my responsibility as a nurse to equip myself with the appropriate training in communication skills and leadership skills so that I can understand the patients and my colleagues even better (Doel, Sawdon, and Morrison, 2002; Wigens, 2006).
Role of cultural competency when delivering healthcare to geriatric population
By using good communication behaviour, the patients will explore their worries and feelings such that a nurse can find an effective way to help them cope with emotional suffering. I have also learnt that the patients needs and carer’s needs as well as decision making preferences vary considerably (Illes & Sutherland, 2001). It is important for a nurse to listen to them in order to l identify the most effective approach to address these conflicting ideas. In the futures, I will elicit patients concerns. As I have mentioned, I have learnt that patients gives cues of their main beliefs or concerns. I will look for hidden hints in trivial comments. In the future, I seek strategies to help improve patient’s awareness and to identify reasons for establishing a support system. If need be, I will incorporate religion and humour into practice (Bassey & Melluish 2013).
Through the trainings, I have developed good communication skills in both written and oral with the elements of confidence and assertiveness. I feel confident and in a position to apply these skills to such situations. I am also caring, compassionate, kind and above all generous. These attributes have given me the ability to interact with other colleagues and patients with ease (Like 2011). Through an efficient approach of communication, I will be able to include cultural competency in nursing practice.
Work plan / tasks to do for next few days, plus any other comments
Although nursing best practice is achieved through experiences, professional trainings form a good foundation for success. My work placements acknowledge the importance of these skills and have programmed professional development training modules for every week. The next training module is on health and safety. This is important because nurses interact with patients for a longer time than the physicians. Basically, the training will incorporate aspects such as risk assessment, risk management and the process of reporting these assessments (Shannon 2012).
This will help me in learning strategies on risk mitigation. This requires good communication skills. The next training is on leadership skills. The module comprises of strategies to improve individual interpersonal skills. This will help improve the productivity and teams performances. The next training that I am looking forward to is on time- management skills. This is an important aspect for nurses in order to help them balance work and their social life. This will address on issues such as adequate sleep, taking of good diets and some exercises and other strategies to prevent burnout (Long 2016). In addition, at the end of my work placement and graduating, I wish to further my education to Master level. I will also be looking into getting a job; therefore I will be amending my CV and personal statements. I will be using the resources provided by the institution to prefect job searches.
Conclusion
This module has enabled me to undertake toa work-based placement which is appropriate to my career aspirations. In the course of the module, I have developed skills and competences that will help me solve clinical dilemmas in the workplace. I can now reflect critically on my practices and establish a healing environment that supports cultural competency. I understand the dynamic nature of the healthcare culture, nature and structure of organizations; and I am able to evaluate the implications for effective inter-professionalism.
References
Moore. A. (2013). A Holistic Approach to Patient Care. Available: http://www.hsj.co.uk/a-holistic-approach-to-patient-care/5053179.article. Last accessed 6th May 2016.
Bassey, S., & Melluish, S. (2013). Cultural competency for mental health practitioners: a selective narrative review. Counseling Psychology Quarterly, 26(2), 151-173. Available: http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=88071034&site=ehost-live
Campinha-Bacote, J. (2013). Many Faces: Addressing Diversity In Health Care. Online Journal of Issues In Nursing, 8(1), 123-130. Available: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=16508310&site=ehost-live
Care Quality Commission. (2009). Care Quality Commission. Retrieved 22 December 2010 from http://www.cqc.org.uk/
Department of Health. (2010). Equity and Excellence Liberating the NHS. Available:http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
Doel, M., Sawdon. B., and Morrison, D. (2002). Learning, Practice and Assessment: Signposting the Portfolio. Jessica Kingsley. London
Duke, J., Connor, M., & Mceldowney, R. (2012). Becoming A Culturally Competent Health Practitioner In The Delivery Of Culturally Safe Care: A Process Oriented Approach. Journal Of Cultural Diversity, 16(2), 40-49. Available:http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=41875733&site=ehost-live
Fleming, B. D., Thomas, S. E., Shaw, D., Burnham, W. S., & Charles, L. T. (2015). Improving Ethno cultural Empathy in Healthcare Students through a Targeted Intervention. Journal Of Cultural Diversity, 22(2), 59-63.Available: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=103025130&site=ehost-live
Gustafson, D. L., & Reitmanova, S. (2012). How are we ‘doing’ cultural diversity? A look across English Canadian undergraduate medical school programmes. Medical Teacher, 32(10), 816-823. Available: http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=53786565&site=ehost-live
Henwood, M. (2006). Effective partnership working: a case study of hospital discharge Health and Social Care in the Community 14: 4 400-407
Hull. C., Redfern. L., Shuttleworth, A. (2005). Profiles and Portfolios A Guide for Health and Social Care, 2nd Edition Palgrave : Basingstoke
Illes, V., & Sutherland, K. (2001). Organisational Change in the NHS A review for health care managers, professionals and researchers. London: NCCSDO.
Jackson. C., and Thurgate. C., (2011). Workplace Learning in Health and Social Care A Students Guide. Maidenhead, OUP
Jasper. M. (2003). Beginning Reflective Practice. Cheltenham, Nelson Thornes
Jenny. M. (1999). Reflection in Learning and Professional Development. London: Routledge Falmer .
Like, R. C. (2011). Educating clinicians about cultural competence and disparities in health and health care. Journal of Continuing Education in the Health Professions, 31(3), 196-206. Available: http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=65804280&site=ehost-live
Long, T. (2016). Influence Of International Service Learning On Nursing Students’ Self Efficacy Towards Cultural Competence. Journal Of Cultural Diversity, 23(1), 28-33. Available: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=114334347&site=ehost-live
Naidoo. J. & Wills. J. (2003). Health Promotion. Foundations for Practice. Edinburgh, BailliereTindall.
Owen. S.M., and Leva. S. (2009). Experiential placements and scaffolding reflection. Learning in Health & Social Care, Dec, Vol. 8 Issue 4, p272-281,
Santy. J., & Smith. J. (2007). Being an E-Learner in Health and Social Care A student’s Guide London Routeledge
Shannon, D. (2012). Cultural Competency in Health Care Organizations: Why and How?. Physician Executive, 36(5), 18-22. Available: http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=53744263&site=ehost-live
Wigens. L. (2006). Optimising Learning through Practice. Cheltenham, Nelson Thornes
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