professional relationship. This can result in a loss of trust or poor communication and lead to adverse health, emotional and psychosocial outcomes. These adverse outcomes may be manifested in many ways -such as failure to follow up with appointments, failure to communicate symptoms or concerns, or experience negative feelings toward the treatment process or prognosis. Each of the patients discussed would benefit from a culturally sensitive approach using skills that recognize the patients’ values and consideration of other factors in their decision-making processes, as well as a respect for the role of their family in the decision-making. improve decision-making and care; thus eliminating health disparities. The Accreditation Council for Graduate Medical Education (ACGM) includes the following content related to cultural competency in the areas of professionalism, practice based learning, self- evaluation, and reflection to enhance patient care. These areas are included in the protocol for education and accreditation programs for medical practitioners. Professionalism Practitioners must demonstrate a commitment to carry out professional responsibilities and an adherence to ethical principles. They are expected to demonstrate: ● Compassion, integrity, and respect for others; ● Responsiveness to patient needs that supersedes self- interest; ● Respect for patient privacy and autonomy; ● Accountability to patients, society and the profession; and ● Sensitivity and responsiveness to a diverse patient population, including (but not limited to) diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. ● Systematically analyze practice using quality improvement (QI) methods, and implement changes with the goal of practice improvement. ● Incorporate formative evaluation feedback into daily practice. ● Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems using evidence-based medical research and best practice. ● Use information technology to optimize learning. ● Participate in the education of patients, families, students, residents and other health professionals. consequences of making assumptions. Health disparities result from miscommunication, stereotypes, biases and lack of access that may extend beyond the practice, and into the community at large. Knowledge of these causes is the first step toward actions to address health disparities.
believes will respond favorably to chemotherapy, may instead choose an experimental alternative treatment -or prayer and meditation. This can happen even after evidence of these modalities’ ineffectiveness is presented to him. A patient of Chinese origin raised to expect a paternalistic relationship with his caregivers, when faced with a similar diagnosis, may choose chemotherapy over traditional Chinese medicine. He may do this not because of the available evidence presented, but out of respect and deference to his health provider’s opinion. In addition, either patient may value the input of family members. A rigid “one-size-fits-all” approach to persuade both patients to undertake a treatment as the only option can damage the Practicing in a culturally competent way Cultural knowledge Communicating with clients and patients in a manner that is open to consideration of their personal, community, spiritual, family and social values is one step toward establishing the foundation of a culturally sensitive practice. As previously reviewed, medical education emphasizes an approach that avoids categorization of clients and patients by race, language, orientation, or religion to avoid stereotyping. There is, instead, an emphasis on an approach that recognizes the individuality and uniqueness of every client using “cultural humility.” Cultural humility is defined as the “ability to maintain an interpersonal stance that is other-oriented, or open to the other, in relation to aspects of cultural identity that are most important to the person” (Asbill & Waters, 2013). Massage therapists should recognize that patient values and culture affect their perceptions concerning health and illness, biases toward options for care, and their role in providing a culturally appropriate experience in the health care setting. Therapists need to recognize and address their own attitudes and potential barriers to informed decision-making. A therapist’s attitudes can affect health care outcomes. Awareness of their attitudes and biases can Practice-based learning and improvement (PBLI) Practitioners must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Practitioners are expected to develop skills and habits to be able to meet the following goals: ● Identify strengths, deficiencies, and limits in one’s knowledge and expertise for self-assessment and reflection. ● Set learning and improvement goals. ● Identify and perform appropriate learning activities. Section summary Effective cross-cultural communication skills focus on client/patient-centeredness, negotiation, shared decision- making, recognition of the patient’s values and beliefs and the family and community’s involvement in the patient’s health. Eliciting the patient’s views of his or her health is imperative in avoiding stereotyping and the negative Scope and impact of the problem Language barriers to health care in the United States There is more than one way for a language-related misunderstanding to occur between a patient and a healthcare provider. According to the New England Journal of Medicine (NJM) (Wynia, Ivey, & Hasnain-Wynia, 2014): One of the ways, becoming more familiar all the time in many parts of the country, is a mismatch of language backgrounds, the doctor speaks and understands
SECTION 4: WORKING EFFECTIVELY WITH INTERPRETERS
only English; the patient speaks and understands only Spanish or some other language. That may lead to humorous exchanges, or to tragedy, the author of one report cites a case in which a Spanish-language mother was forced to relinquish custody of her children on suspicion of abuse after a nurse and a social worker misunderstood the mother’s assertion that her two-year- old had “hit herself” when falling off a tricycle.
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Book Code: MMD0724
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