Culturally sensitive communication in healthcare: A concept analysis

BackgroundLimited guidance exists on culturally sensitive communication related to interactions between clinicians, patients and families.ObjectivesTo explore the concept of culturally sensitive communication and identify clinical practice implications and knowledge gaps related to culturally sensitive communication in healthcare.MethodsA concept analysis was undertaken, using Walker and Avant’s (2011) framework which comprises eight consecutive steps to explore the concept and clinical practice implications. A systematic literature search was undertaken to identify papers published between January 1, 1995 and December 20, 2017, leading to the inclusion of 37 relevant research papers in the concept analysis.ResultsBased on the research literature, examples of model, borderline and contrary cases of culturally sensitive communication were developed. Three major uses of culturally sensitive communication were identified, including understanding one’s own culture, open and sensitive communication, and strategies to collaborate with the patient and family for optimal patient care. An awareness of one’s own cultural beliefs, values, attitudes and practices was identified as an essential first step before learning about other cultures. This awareness includes being sensitive and adaptive to individual cultural differences and relies on clinician self-understanding and reflection. Strategies to collaborate with the patient and family for patient care include respectful and supportive clinician interactions with the family that enable a collaborative approach to care.ConclusionsThis concept analysis aids understanding of culturally sensitive communication, the benefits and challenges associated with its use, and clinical practice implications.     

Culturally sensitive care: managing diabetes during Ramadan

Diabetes and its treatments can cause problems for Muslims who wish to take part in the fast during the holy month of Ramadan. This article offers information about the impact of various diabetes treatments, including insulin, when fasting and some of the precautions that need to be in place. Some of the reasons people with diabetes might find it difficult to comply with advice are explored with some suggestions on how to work towards acceptable compromises. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual.     

A newborn with Beals syndrome

We present the case of a newborn with multiple connective tissue abnormalities. Careful examination of the infant and a detailed history from his mother indicated that they were both affected by Beals syndrome (congenital contractural arachnodactyly). A viable-term male infant was delivered to a healthy 30-year-old. The parents had no known history of familial birth defects. After delivery, it was noted that the infant could not extend either elbow past 90 degrees. Further examination revealed a crumpled helix of the ear, ulnar deviation of the fingers, campylodactyly, and hyperextensible ankles. Further questioning revealed that the mother also had hyperflexible wrists and ankles, and several dislocations of both patellae in childhood. She never received a diagnosis or treatment for her condition. A careful examination of newborn deformities and extensive history-taking from the parents can reveal previously unknown genetic traits. Thus, initiating early screening and intervention can positively impact a child's future.     

Culturally sensitive communication at the end-of-life in the intensive care unit: A systematic review

ObjectivesThe objectives of this systematic review were the following: (i) to describe whether culturally sensitive communication is used by clinicians (nurses and physicians) when communicating with patients and families at the end-of-life in the intensive care unit and (ii) to evaluate the impact of culturally sensitive communication at the end-of-life. The systematic review question was how is culturally sensitive communication used by clinicians when communicating with patients and families at the end-of-life in the intensive care unit?Data sourcesA search of CINAHL, MEDLINE, Embase, and PsycINFO databases identified all peer-reviewed research evidence published in English between January 1994 and November 2017. Two authors independently assessed articles for inclusion. From the 124 articles resulting from the search, nine were included in this systematic review.Review methodsArticles were independently assessed for quality by two authors using Caldwell et al.'s framework to critique health research. The data available in this systematic review were heterogeneous, with varied study designs and outcome measures, making the data unsuitable for meta-analysis. The most appropriate method for data synthesis for this systematic review was narrative synthesis.ResultsFrom the narrative synthesis, two major themes emerged: communication barriers and cultural and personal influences on culturally sensitive communication. Communication barriers were identified in eight studies, influencing the timing and quality of culturally sensitive communication at the end-of-life. Cultural and personal influences on communication at the end-of-life was present in eight studies.ConclusionsThe findings of this systematic review show that clinicians lack the knowledge to enable effective interaction with culturally diverse patients and families at the end-of-life.     

Delirium superimposed on Charles Bonnet syndrome: A case study

Older adults with visual impairment may experience visual hallucinations in the setting of normal cognition and absence of psychiatric illness. This phenomenon is referred to as Charles Bonnet syndrome. Information concerning Charles Bonnet syndrome predominantly comes from case studies. Reassuring the person experiencing the hallucinations they are not suffering from psychosis constitutes the mainstay of treatment. What follows is the case of a vision impaired, older adult male with known Charles Bonnet syndrome, who, following emergency surgery and associated delirium while in the intensive care unit, experiences an aggressive change in hallucinations. Nurses need to understand the pathology and characteristics of Charles Bonnet syndrome in order to distinguish it from other pathologies underlying hallucinations. This knowledge is necessary to provide safe, patient-centered care for older adults.     

Rett's syndrome: a case study

Rett's syndrome, first described in Austria in 1966 by Dr. Andreas Rett, became known as such in 1983 when Dr. Bengt Hagberg in Sweden realized that he and his colleagues from France and Portugal were not the first to recognize this disorder. In Sweden the syndrome was found to occur in at least 1 per 15,000 female births by 1985, about twice that of phenylketonuria (PKU) in the same area. The syndrome is limited to girls and involves atrophy of the brain with loss of previously learned cognitive and motor skills after eighteen months of age. Although there are variations in the numerous clinical features, most girls develop seizures, muscle wasting, contractures, severe weight loss and bizarre behaviors. All races are affected and four clinical stages have been established. Nurses are more likely to become involved during the final stage of this disorder when families can no longer cope without professional intervention. A case study of a 9 year-old girl is presented.     

Post-thrombotic syndrome: a case study

Post-thrombotic syndrome is a common complication following deep vein thrombosis. The severity and incidence of this condition can be considerably decreased with the use of compression hosiery. This article focuses on a case study of a patient who had post-thrombotic syndrome for ten years before receiving effective treatment.     

Patient with Dravet syndrome: A case report

Dravet syndrome is rare genetic epilepsy syndrome and epileptic encephalopathy. The patient initially has normal developmental profile with plateau or regression that begins after seizure onset. We report a case of two‐year‐old child diagnosed as dravet syndrome with moderate cerebral atrophy and ventricular dilatation as rare MRI finding.     

Breaking down barriers to treat a patient with a germinoma: a case study.

Germinomas are the most common type of germ cell tumor occurring commonly before the second decade of life. Because of the radiosensitivity of germinomas, traditional treatment following diagnosis has been conventional radiotherapy. The desire to defer radiotherapy to avoid the delayed neurocognitive effects has led researchers to investigate the use of up front chemotherapy. A major limitation in using chemotherapy for brain tumors has been the inability to deliver drugs across the blood brain barrier. The blood brain barrier consortium has developed chemotherapy protocols for patients with malignant brain tumors through the use of reversible osmotic opening of the blood brain barrier. While the patient is under general anesthesia, osmotic opening or disruption is achieved by a 30-second intracarotid infusion of mannitol. The mannitol infusion is followed by both intraarterial and intravenous chemotherapy. By administering chemotherapy in conjunction with blood brain barrier disruption, drug delivery to the tumor and the brain around tumor is increased.     

A case of Barber‐Say syndrome in a male Japanese newborn

We reported a case of Barber‐Say syndrome (BSS) in a Japanese newborn. Distinctive features of BSS were found; macrostomia, gingival dysplasia, cup‐shaped low‐set ears, wrinkling redundant skin, and hypertrichosis. Fundus showed subretinal drusenoid deposits, a novel finding of BSS. Genetic analysis is underway using next‐generation genome sequencing and microarray analysis.     

Chronotropic incompetence in persons with down syndrome

OBJECTIVE: To investigate the chronotropic response to exercise through peak heart rate and the Chronotropic Response Index (CRI) in participants with Down syndrome (DS) and in nondisabled control participants. DESIGN: Comparative study describing the acute exercise heart rate response. SETTING: University sports medicine facility. PARTICIPANTS: Twenty participants with DS (mean age +/- standard deviation, 24.2+/-3.5y) and 20 control participants without disabilities (age, 21.2+/-2.8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal treadmill exercise tests with metabolic and heart rate measurements. Maximal heart rate and the CRI were considered main outcomes. RESULTS: The peak oxygen consumption (41.7 vs 31.8mL. kg(-1).min(-1)) and peak heart rate (165+/-14.7 vs 192+/-7.7 beats/min) were significantly lower in participants with DS than in controls (P<.05). The CRI was below normal (.84+/-.25) in participants with DS and was normal (.97+/-.07) in controls. CONCLUSION: Both the CRI and the peak heart rates were indicative of chronotropic incompetence in participants with DS, but not in controls. The CRI of the participants with DS was similar to that reported for nondisabled populations who have a true chronotropic response to exercise. The CRI indicated that the low peak heart rate in our participants with DS was a true chronotropic response.     

The hand-foot-uterus syndrome: a case study

An autosomal dominant syndrome is described in 26 members of six generations in a single family. Distal extremity malformations are characteristic and superficially resemble those of arthrogryposis, chondroectodermal dysplasia, Cornelia de Lange syndrome, Faconi's anemia or Holt-Oram syndrome. There is an absence of spinal deformity, and females of the disorder have duplication of the genital tract.