RUNNING HEAD: DEVELOPING PROFESSIONAL PRACTICE
Developing Professional Practice using Gibb’s Reflective Cycle
Challenging communication encounter
Last semester, I attended my Complex Care Nursing placement in the Coronary Care Unit. One of the clients was a fifty three year old woman, and a Muslim. The patient had been admitted to the ward on 16th July, 2012 with arteriosclerosis. The patient spoke French fluently and only understood and spoke few English words. My male colleague could have translated what the woman was saying, but she could not agree to being attended to by male professionals. She could not communicate effectively in English, and for us to communicate therefore; one of her family members had to be present for translation. In case her family members were unavailable, I had to try my best and communicate with her all by myself. Moreover, the patient never wanted to be attended to by male nurse. My male colleague could therefore, not attend to her. I had to take care of this patient all by myself.
I realized that when the male colleague accompanied me to attend to the woman, she never made attempts to express herself or she refused to talk. Sometimes, the patient became aggressive and resulted to talking to herself. While on duty one morning, I saw the patient trying to come out of bed, and she had been given a bed rest. I walked up to her and motioned that she should not come out of bed. She shouted in French at me. Although I did not understand what she was saying, I guessed that she was telling me to leave her alone to do what she wanted. I called my male colleague to tell her that if she got out of the bed, her discharge would be delayed. Even though, she disliked the idea of being addressed to by a male nurse, she paid attention and made efforts to get back to bed. After that, she was always obedient to what I told her so that she would be discharged quickly. She became my friend from then and always enquired of the day she would be discharged. She talked to me in French always thinking that I understood. I used nasal- gastric tubes to feed her every morning, and she was almost healed by the time I finished my placement. The encounter has impacted on me tremendously in realizing that effective communication is principal to the health outcomes of the patient, and that language influences effective communication. The patient shall be referred to as MBN.
Stages 2, 3, 4 and 5
The patient had been in the ward for two weeks by the time I finished the placement. I felt happy that the patient had learned to obey my instructions even though she never heeded to instructions at the beginning. Considering that she only knew French, it was difficult to communicate with her using the few English words she knew. I felt sorry the patient could not express her feelings to other patients and people in the ward. No one understood her. Language barrier rendered the patient vulnerable. Both the general public and the nursing profession expect nurses to have the ability to communicate effectively with patients so as to achieve desired patient outcome (Davis, 2004).
In my reflection, I realized that people who do not have a common language and are trying to communicate faced a lot of difficulties. Cheek and Gibson (1996) argues that language barrier is likely to lead to medical errors in health facilities by impending provider patient communication. Being a student, I felt extraordinarily sensitive as far as patient needs are concerned. The notion of individualized care approach based on the individual’s unique needs was uppermost in my thoughts as I approached MBN to interact with her. After the reflection, I now know that language expertise is principal to effective communication. According to Street (1995) language barriers are linked to lower patient satisfaction and less health education. Research shows that patients who converse in different languages from their doctors have a less likelihood of receiving lifestyle counseling on exercise, diet and smoking cessation. Considering that MBN had a heart condition, it is extremely essential that she received lifestyle counseling on how she can manage the condition. According to DeFleur, Kearney and Plax, 1993), access to clinical interpreters ensures health education and overcomes language barrier partially. Patients who are able to talk to their doctors directly are more satisfied.
After analyzing the entire situation, I released that language barrier and religious beliefs impact considerably on the patient’s health outcomes. One impact of international migration is that professionals in health care institutions face a wide array of patients with whom they have no common language (Atkins and Murphy, 1994). At the same time, they are required to offer health care of the highest quality to patients as expected by human equity and right principles.
It is worth noting that patients using interpreters get better health outcomes (Stephenson, 1993). Studies indicate that religious beliefs and language barrier should not be ignored in conventional healthcare services (Jay, 1995). This is due to the fact that they produce substantial long term costs if ignored. A nurse in a Coronary Care Unit has a role of communicating effectively with patients. Therefore, it is noteworthy that a common language exists between the patient and health care provider. I am now aware that a common language between nurses and patients plays a truly vital role in communication. This in turn, is reflected in positive patient’s health outcome (Johns and Graham, 1996).
All incidents are critical and the action taken can lead to ineffective or effective outcomes (Haddock and Bassett, 1997). As a student nurse, I had to consider the patient’s character, limitations, strengths, qualities, values and beliefs so as to be able to offer quality care. It involves knowing all surrounding factors that can hinder quality care (Beattie, Check and Gibson, 1996). It is extremely critical that health care systems should train and recruit additional bilingual providers so as to satisfy patient needs. Health care professionals should be taught languages spoken by the surrounding nations so that effective care is given to the neighbors who at times visit the health facilities (Schon, 1983). Miscommunication results from the language barrier and it results to grave catastrophes. Because of the communication I had with MBN even though impaired, it did marvelous in helping him get bed rest and take her drugs, therefore, recover quickly (Gibbs, 1988).
Culturally appropriate communication is necessary in health care setups (Kolb, 1984). Nurses providing health care should focus on culturally safe care, transcultural nursing and heath care systems that are culturally competent. In ensuring health care systems that are culturally competent, it is indispensable to offer health care settings that are culturally specific. Interpreters come in handy in such situations as well as culturally diverse staff. Patients and staff need to be educated using the language and culture of the community. This ensures counseling and diet advice given relates to the needs of the community. The instructional and signage literature used should be done using the client’s language (Gibbs, 1988).
When counseling patients; consider the dietary, religious, and health practices and beliefs in order to offer beneficial advice. For instance, planned treatment or care may be at a time when some religious practices of festivals are happening. The patient may not concentrate on the advice being given as they are preoccupied with the festivals. Food consumed varies depending on religious restrictions. When giving dietary advice, alternative foods should be mentioned so as to ensure the patient gets the necessary nutrition.
Cross-cultural communication consumes a fabulous deal of effort and time. There is the possibility that a patient is mentally translating what is being said and forming responses before answering (Palmer, Burns and Bulman, 1994). Therefore, family members can be involved in the conversations and more time given to clients before they answer.
Cooperation amongst health care providers
My plan of action is to work always together with other health care professionals, and as part of them so as to ensure positive patient health care results. In addition, I will have an interest in learning more about communication and language. Being familiar with other languages is tremendously valuable as one can assist in a situation where there is communication barrier. Even if, not attending to a patient, talking to patients using their language lifts their spirits, especially when from different nationalities.
Professional training schools
I will influence health care decision makers so that they start teaching other languages in professional training schools. Moreover, I will arrange short courses for practicing health care professionals where they can teach other the basic words in other languages, as well as facial expressions and sign language (Schon, 1983). This is because facial expressions and sign language imply different things depending on one’s culture. A sign may mean different things depending on the culture. This can be accomplished through dissemination and research publications on a regular basis during health managers’ meetings.
In cases where there is a language barrier, interpreters can help improve the quality of health care provided. It is crucial to inform clients that interpreters are available at no cost. Some clients have the notion that they be charged if they seek the assistance on an interpreter. In addition, clients may not know that they can use the services of an interpreter or may not know the process of requesting for one. Ghaye and Lillyman (2000) assert that there are many factors to consider before deciding to seek an interpreter. Some clients are sensitive about confidentiality and their English proficiency level. Clients should therefore, be asked whether they require the services of an interpreter. In instances where the client is unable to answer straightforward questions since they do not understand what is being asked, an interpreter should be sought. Interpreters are used for various reasons (Gibbs, 1988). Among these are accountability, confidentiality, impartiality, accuracy, integrity, ethical and accreditation reasons.
Interpreters should have the ability to converse with patients using even sign and body language so that they understand what critically ill patients are communicating. Interpreters can be the staff, on the telephone or on call.
Effective government policies ensure that patients are provided with the best health care services irrespective on their linguistically and culturally varying backgrounds. It is worth noting that the marginalized and vulnerable groups in the society face a lot of health problems. Health disparities have roots in social structural inequalities, such as discrimination and racism. Implicit or overt discrimination is against human rights principles. Government approaches should be put in place to ensure that linguistically and culturally different backgrounds, access quality health care (Fitzgerald, 1994).
So as, to curb the cultural challenges in health care provision, practitioners require a wide range of cultural competence skills. Cultural differences exist in both verbal and nonverbal communication. I will put measures in place to ensure health care professionals have the key skills necessary to ensure effective communication. These include patience/ lack of hurriedness when speaking to the patient, showing respect and social introduction. To ensure the providers gain these skills, manuals will be given to them so that they go through them, and practice during medical rounds. In addition, more detached or personalized interaction modes will be used, choose indirect versus direct approaches, and touch, proxemics and silence therapeutic use. Health care providers have to be particularly keen when selecting the communication model to use for particular patients. For instance, indirect communication is more preferable for Hispanic and Native American patients, as opposed to instruction and direct questioning.
The indirect approach could have worked extraordinarily well for MBN. I had the responsibility of interacting with the patient as an equal as opposed to an authority. The patient becomes more open when the conversation is based on a personal and equal level. When speaking with the patient, immediate or direct responses should not be expected. In addition, ties can be established through common locations, friends and relatives. This was the case with MBN when a family member used to translate for me. Indirect referencing should be used when advising the patient. For example, saying “a person who has arteriosclerosis might have the following risks.” This creates awareness in the patient without having them pity themselves too much, as would have been the case when using direct referencing. Health care institutions should ensure that their workers have the skill to avoid confrontation and incorporate humor when discussing serious matter with the patient. This aims at providing balanced communication. I will ensure that workers can correct their colleagues or teach them the skills necessary to provide quality health care, without receiving negative responses and attitudes.
A cultural assessment refers to a systematic and focused appraisal of practices, values and beliefs aimed at determining the substance and context of client needs. Consequently, the best health interventions are evaluated and adapted. Cultural assessment is necessary during evaluation, intervention and problem identification. Irrespective of the fact that cultural assessments do not tackle all cultural aspects, they are effective with elements related to problem identification, the most effective intervention and evaluation (participatory). The views that the family and client have regarding the optimal treatment choices are reviewed during evaluation.
It is necessary for hospital managements to ensure that their workers conduct cultural assessments before selecting the intervention to be used. During the placement, I ensured that I interacted with MBN adequately so as to identify all the cultural aspects that may affect her treatment. This should be the case with student nurses and professional workers. Hospital managements can do appraisals regularly to ensure the cultural needs of all their patients are catered. Health providers require the skills to develop and select the most effective interventions at every level of treatment. Interventions can be culturally neutral, innovative, sensitive or transformative interventions. Providers will be equipped to all the knowledge so that they can make effective decisions when dealing with patients.
In a nutshell, it is extremely significant that health care institutions focus on providing care to clients in a culturally competent system. Hospital managements should initiate programs that retain and recruit staff members who are keen about the community’s cultural diversity. Health care settings that are culturally specific ensure satisfied health care needs. In cases of a language barrier, the services of bilingual providers or interpreters can be sought for patients having limited English proficiency. Cultural competence programs will form part of professional training.
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