Family Physicians, 2019). The standards are divided into four areas: (1) The principal standard; (2) governance, leadership, and workforce; (3) communication and language assistance; and (4) engagement, continuous improvement, and accountability. Standards 2–15 aim to meet the standard principle "Provide effective, equitable, understandable, and respectful quality care and services that are responsive Case Study #2: Cultural Competence Marcus is a 64-year-old Orthodox Jew who was admitted for end-stage renal disease. Initial assessment reveals +3 edema to the lower extremities and shortness of breath with complaints of nausea, vomiting, loss of appetite, and fatigue and drowsiness. He was unable to receive dialysis today because of a failed arteriovenous shunt. Questions 1. What important cultural belief should the provider be aware of when treating Marcus? 2. To determine if this cultural belief is relevant in the care of Marcus, what should the provider do? Discussion 1. Most Orthodox Jews follow Halacha, the Jewish Law central to the Orthodox Jewish identity. Within Halacha is the vital principle of Pikuach Nefesh, saving or preserving life, which is a fundamental principle in receiving healthcare (Bressler & Popp, 2018). When it comes to providing care, especially if it is considered end-of-life care, the provider must consider saving or preserving life. According to the Halacha, the patient may request a rabbinic adviser to assist in deciding if the course of action that should be followed is discretionary, prohibited, or required. According to the rabbi's decision, the patient's preferences can be followed in the treatment plan only when it is discretionary. The providers need to understand the gravity of the decision made by the rabbi, which is based on the information and options presented by the provider to the rabbi. There needs to be sensitivity and patience in the decision process for the rabbi and the patient. Other information that should be shared is how to differentiate decline as a side effect of medications versus disease- related effects. This information helps the rabbi, patient, and family members understand that the treatment is not hastening death, which contradicts Pikuach Nefesh, preserving life. Because of the fear of hastening death, healthcare providers may have to give counterintuitive treatments, such as vasopressors that counteract opioid-induced hypotension. Counterintuitive treatments may also be requested for patients who are Catholic, as a similar belief is seen in Catholic bioethics. Finally, providers should offer education and understanding in discussing do not resuscitate (DNR) orders. Some rabbis may advise the patient to decline to agree to a DNR order because they fear that treatment to preserve life may be withheld in a way that contradicts the halacha. For this reason, the rabbi's advice may be to not agree to the DNR until death is imminent. 2. The provider should ask Marcus what preference he has for determining the next steps in his care. He should be encouraged and supported to share whether he needs a rabbi to help determine the next steps in his treatment plan.
to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs" (U.S. Department of Health and Human Services Office of Minority Health, n.d.). Before continuing in the course, take some time to familiarize yourself with the national standards at thinkculturalhealth.hhs.gov. Mitigating implicit biases in healthcare is of utmost importance for several critical reasons: ● Equitable Care: Implicit biases can lead to unequal treatment of patients based on their race, ethnicity, gender, age, socioeconomic status, or other personal characteristics. Addressing these biases is essential to ensure that all patients receive fair and equitable care, promoting better health outcomes for diverse populations. ● Patient Trust and Satisfaction: When patients feel understood, respected, and valued by their healthcare providers, they are more likely to trust and engage in their medical care. Reducing implicit biases can lead to stronger patient-provider relationships, improved communication, and increased patient satisfaction. ● Accuracy of Diagnosis and Treatment: Implicit biases can lead to misdiagnosis or undertreatment of certain conditions. By mitigating biases, healthcare professionals can make more accurate diagnoses and provide appropriate and timely treatment, leading to better patient outcomes. ● Improved Patient Safety: Addressing biases is crucial for patient safety. When healthcare providers are aware of their biases, they are less likely to rely on assumptions or stereotypes that could compromise patient safety or result in medical errors. ● Reduction of Healthcare Disparities: Implicit biases contribute to healthcare disparities, where certain racial, ethnic, or marginalized groups experience poorer health outcomes and limited access to quality care. Mitigating biases is a crucial step in reducing these disparities and promoting health equity. ● Better Collaboration and Teamwork: Mitigating implicit biases fosters a more inclusive and supportive healthcare environment. When healthcare professionals work together without biases, it enhances collaboration, teamwork, and the overall quality of care provided. ● Ethical Obligation: Healthcare professionals have an ethical duty to provide compassionate, non- discriminatory care to all patients. Addressing implicit biases aligns with these ethical principles and ensures that patients receive care that upholds their dignity and human rights. ● Professional Development: By confronting and mitigating biases, healthcare professionals can enhance their self-awareness and cultural competence. This ongoing personal development can improve their ability to understand and meet the diverse needs of their patients effectively. ● Legal and Regulatory Compliance: Many countries have laws and regulations that prohibit discrimination in healthcare. Addressing implicit biases helps healthcare organizations and providers comply with these legal requirements and promote a more inclusive healthcare system. ● Positive Organizational Culture: A healthcare environment that actively addresses biases fosters a positive organizational culture. It attracts and retains diverse talent, promotes employee satisfaction, and enhances overall workplace morale.
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