Amywdouglas.weebly.com



Ethical Nurse Practitioner practice; dealing with cultural diversity in primary care:Amy Douglas, Kailey Hamrick & Skyler SherrellObjectives:To gain a better understanding of the definition of cultural sensitivity and culturally competent healthcare and how to practice it.To identify facilitators of practicing culturally competent healthcare and ways to use these facilitators.To identify barriers of practicing culturally competent healthcare and ways to minimize these barriers.To recognize positive outcomes that can be obtained by providing culturally competent care.To identify follow-up measures that could be used to evaluate the effectiveness of the strategies used to provide culturally competent healthcare.Objective 1: To gain a better understanding of the definition of cultural sensitivity and culturally competent healthcare and how to practice it.-What is cultural Diversity? This is a broad definition that includes variants in age, economic background, education, ethnicity, gender identity, geographic background language spoken, marital/partnered status, physical appearance, political affiliation, race, religious beliefs or sexual orientation.-Cultural sensitivity in healthcare: “the ability to be appropriately responsive to the attitudes, feelings or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic or cultural heritage.” According to the American College of Physicians, one of the major contributors of health care disparities is culturally insensitive healthcare systems. -Culturally Competent Healthcare: Care in which health care providers can deliver healthcare in an appropriate and effective manner to culturally diverse individuals. This can be accomplished by reducing communication barriers through the use of teaching tools and interpreters, insuring that providers have a clear understanding of various cultures and the beliefs and practices associated with them, and by showing genuine care and respect to patients of all cultures.-7 Ethical principles and rules to guide nursing practice: ?Nonmaleficence/Beneficence – obligation to do no harm?Autonomy – respecting the right of all people to make choices and decisions based on their own individual values and beliefs?Respect – treating all people, including patients, coworkers, self and workplace with a sense of worth?Fidelity – the duty of honoring commitments made to others?Confidentiality – lack of sharing information and allowing each person to have his or her own time and space alone?Veracity – actions and beliefs that are based on values of truth, accuracy and honesty?Justice – all people should be treated fairly and available resources should be used equitablyObjective 2: To identify facilitators of practicing culturally competent healthcare and ways to use these facilitators.Decrease stigmas and preconceived notions: Television and radio are notorious for not always portraying 100% truthful stories. Because of this, individuals are left to draw their own conclusions related to the information that they have been delivered. As healthcare providers we must distance ourselves from this and make sure that when providing care we do not allow these stigmas to affect our interactions. This can have a great impact on the trusting relationship between patient and provider. CEUs related to cultural diversity: We are aware that CEUs are required for license renewal. There are a wide variety of categories, which includes cultural diversity. These courses allow us to see how to best communicate and how to provide the best care possible for individuals across cultural lines.Technology: Access to technology allows the healthcare provider to be more well informed about the population that they are caring for. We have the ability to research the specific population in order to make informed decisions on how to approach sensitive subjects. Having a nursing backgroundNurses place the highest value on the patients’ responsiveness and their wishes. Having this background allows nurse practitioners to think from both sides of the spectrum and provide the best care possible. Ethical decision making has always been a large part of the nursing profession. It is integrated into all educational programs and it is an area where nurses pride themselves in excelling.The nursing Code of Ethics. Access to other healthcare providersCollaborating Physician: The collaborative relationship between physicians and nurse practitioners is multifaceted. What many people do not realize is that this relationship is not just directed at the clinical aspect of the patient’s care, but the spiritual side as well. Physicians are available to the nurse practitioner for a variety of issues, including making ethical decisions. The physician often has a different point of view or previous experience that can make the decision making process a learning experience for the NP.Ethics Committee: Because the majority of ethical decisions in hospitals revolve around maintain life, death, or organ donation JCO has developed ethical dilemma standard in which these committees will provide education, consultation and sometimes ethical clinical research. These committees are designed to be an impartial 3rd party who are of assistance to healthcare providers in difficult situations. Chaplain/ Religious services: These services are available in the vast majority of hospital settings. Most religious services encompass a large variety of religions and are designed to provide spiritual comfort during a time of need. Hospital websites typically discuss the purpose of this service and give information in regards to contacting this department in instanced where the healthcare provider has not offered it to the patient or family member. Nurse Practitioners need to be familiar with the services at their facility and use this to ensure that patients are given truly holistic care. Link to Baptist Medical Center’s Pastoral Care page: 3: To identify barriers of practicing culturally competent healthcare and ways to minimize these barriers.1. Patient Family members: Family members who have power of attorney are capable of creating a barrier between the patient and care by the provider. In several instances the most ethical decision cannot be made because the family member is unable to agree. from the article1. 13 year old female who had routine tonsillectomy to correct sleep apnea suffered a massive heart attack and was declared brain dead Dec 12, 2013.2. Patient was declared brain dead by multiple physicians3. Patients mother fought in court to keep patient alive using ventilator support and feeding tubes-How to minimize barrier of patient family members:Education. Provide family members complete and adequate education related to the patients disease process. Ensure that they have an adequate understanding of the patient’s disease process and the long-term goals for the patient.Be sympathetic. Family members who believe that you see the patient as a person are typically much more receptive to the advice of healthcare providers. Understand the reasoning that the family has for the decision that they are making for the patientAllow for time to grieve. Determine if there are any religious rituals that need to be carried out. Use your facilities support systems to achieve any of these goals.2. Time Restraint: The time restraints on healthcare providers are increasing at a rapid rate. They are expected to see more patients in a shorter time, with an increase in overall productivity. -How to minimize barrier of time restraint:Know your patient, history and family history prior to seeing the patient. Review all labs or any necessary diagnostic information that may be pertinent to the patient’s care. Devote your time directly to the family while in the room. Look them in the eye and answer questions to the best of your capability.3. Financials: Uninsured patients pose a great ethical dilemma. Healthcare experts are often forced to make decisions based on the financial impact that the patient will face after discharge or the impact that will be left on their families. Also, price will often have an impact on overall medication compliance. to minimize financial barrier:Be familiar with insurance policies and coverage. Generic medications are typically cheaper than name brand, but knowing the policy coverage is important.Know your resources. Often there are patient access networks, foundation funds, or co-pay assistance programs for those in need. Do not lower standard of care for patients who are uninsured. Though it is at times difficult, there is a way to provide these patients with the quality of care that an insured patient would receive.4. Communication barriers: The number one barrier in providing care in a culturally diverse setting is communication barriers, whether it be language, or how we are approaching the persons involved. For the language barriers, we are all aware of the language lines and translator services that are available, but for the way we approach these individuals, it is a bit more of a gray area. -Tips for this include:Establish the professional’s role and assume authority.Check for understandingBe patient, and consider periods of silence opportunities for reflection on what has been said.Provide clear and full information, such as what is expected from each participant in the discussion.Be attentive to nonverbal cues.Address immediate needs and give concrete advice.Reach consensus by compromising.5. Lack of Knowledge by the Nurse Practitioner: Research the culture. Be well informed about the culture of the patient for which you are caring. There are multiple websites, such as , which are devoted to helping decrease barriers related to cultural diversity. This website is actually linked to a journal that is devoted to educationist and practitioners. 6. Varying cultural norms: Several cultures it is the male who discusses issues such as healthcare, finances and other major decisions. If the patient belongs to one of these cultures, be respectful of the situation, but include the patient and male family member in care.Objective 4: To recognize positive outcomes that can be obtained by providing culturally competent care.-Positive Outcomes Dealing With Cultural Diversity:Facilitate shared decision makingImproved trust in health care providerReduce cognitive and perceived social barriersSelf-efficacyIncrease knowledge of self-care practicesImprove patient’s willingness to seek medical helpAdherence to treatment regimesImprovements in health statuses of patientsReduction in misdiagnosis of patient’s problems due to poor patient-provider communication-Positive Outcomes to Making Good Ethical Decisions:?Patients receive necessary information and support to make informed decisions concerning treatment options?Patients maintain dignity and rights?Providers reap more personal and professional rewards and ensure that they have acted to uphold the duties and responsibilities of the profession?Increased adherence to patient-expressed wishes, better team communication with patient and family?Clearer treatment plan to all involvedObjective 5: To identify follow-up measures that could be used to evaluate the effectiveness of the strategies used to provide culturally competent healthcare.-Follow-up Measures to Evaluate Dealing With Cultural Diversity:Patient satisfaction surveysPre-test and post-test to determine understanding of health care issues, treatment and self-care practicesAssessments to evaluate patient-centered culturally sensitive health-careSelf-assessments for providers and staff to evaluate their provision of care-Follow-Up Measures to Evaluate Ethical Decisions:?Providers will self-reflect to determine what changes should be made when face with same dilemma later?Continuing education courses and tests to determine that providers have the newest and best evidence-based practice ideas and solutions to health care issues?Surveys by family members and patients to determine satisfaction of care received by patients and significant others?Action/outcome response surveys by providers such as: Data analysis with a team-based approach to determine the following: priority concerns, primary nurse action within each incident, action results, and nurses’ regrets. A time to reflect on what can be done differently to improve outcomes for patients, families and providersReferencesCohen, J. & Erickson, J. (2006). Ethical dilemmas and moral distress in oncology nursingpractice. Clinical Journal of Oncology Nursing, 10(6), 775-782Frosh, D., Legare, F. & Mangione, C. (2010). Using decision aids in community-based primarycare: A theory-driven evaluation with ethnically diverse patients. Patient Education Counsel, 73(3), 490-496. Retrieved February 8, 2015 from , A. (1992). Differences in ethical decision-making processes among nurses and doctors. Journal Of Advanced Nursing, 17(2), 129-137.Lofgren, G. (2014). The language of success. Marketing Health Services, 34(1), 14-15.Monteverde, S. (2009). The importance of time in ethical decision making. Nursing Ethics, 16(5), 613-624.Pavlish, C, Saltzman, K., Hersh, M., Shirk, M. & Rounkle, A. (2011). Nursing priorities, actions, and regrets for ethical situations in clinical practice. Journal of Nursing Scholarship, 43(4), 385-395. doi: 10.1111/j.1547-5069.2011.01422.xPharr, E. (2003). The hospital ethics committee: Bridging the gulf of miscommunication and values. Trustee: The Journal For Hospital Governing Boards, 56(3), 24.Tucker, C., Mirsu-Paun, A., Berg, J., Ferdinand, L., Jones, J., Curry, R., Rooks, L., Walter, T., &Beato, C. (2007). Assessments for measuring patient-centered cultural sensitivity in community-based primary care clinics. Journal of the National Medical Association,99(6), 609-619. Weiner, S. (2001). “I can’t afford that!”: Dilemmas in the care of the uninsured and underinsured. Journal of General Internal Medicine, 16(6), 412–418. doi:10.1046/j.1525-1497.2001.016006412.x ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download