Integrating cultural diversity in patient education

Diversity among clients in the American health care system is increasing as the population of the United States changes in composition. Health providers, educators, and supervisors are in unique positions to enhance patient education among members of diverse cultures by incorporating cultural research and health beliefs into patient and staff education. Using a culturally defined framework, health providers can more holistically assess the client and subsequently plan culturally appropriate care.     

Cultural and linguistic competency assessment

The U.S. minority population is rising remarkably. As the population grows and becomes more diverse, the demand for health care services among these groups becomes significant. Health care providers are challenged to understand and address the linguistic and cultural needs of a diverse clientele. When communication barriers prevent health care professionals from obtaining an accurate medical history or understanding their patients symptoms, it is unlikely that proper medical care can be administered.     

Recruiting and retaining a diverse workforce in nursing: from evidence to best practices to policy

Health policy makers, providers, clinicians, and social scientists are among those who have identified racial and ethnic diversification of the health care workforce as one strategy for solving the seemingly intractable problem of health disparities in the U.S. population. But evidence supporting the impact of such diversification on narrowing health disparities is lacking, thus making it unclear if the push for workforce diversification is empirically or politically driven. Moreover, data are largely derived from the study of physicians, making it difficult to generalize findings to nursing and other health professions. This article reviews the evidence that supports the impact of a diverse workforce on patient outcomes and delivery services. Assuming a positive social value in the absence of the data, the authors review the approaches that have been successful in diversifying the nursing workforce. The authors conclude with recommendations for research and policies, including best practices, for enhancing recruitment and retention of a diverse nursing workforce.     

The effect of the clinical nurse specialist on patient outcomes

The review of the literature shows a beginning body of evidence to support the positive effects of CNSs on patient outcomes. The most commonly examined patient outcomes were length of stay, complications, use of health care services, cost, and mortality rates. The study done by the author shows that patients with TKR operations on units with CNSs had better patient outcomes than patients on units without CNSs. Patients on units with CNSs had an overall shorter TLOS and fewer complications than did patients on units without CNSs, which is consistent with the literature. Health care providers are making continuing efforts to decrease operating costs. Because of economic pressures on health care administrators, a need to examine various job positions exists. Decisions regarding which positions are retained or eliminated should be based on well-designed research data. The effect of CNSs on patient outcomes can mean improved quality of care and cost reduction. As more research is conducted to show the effectiveness of CNSs on patient outcomes, health care administrators and consumers may become more convinced that such a person is a valuable member to have on the health care team.     

Customer service: the key to remaining competitive in managed care

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.     

Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers

The implantable cardioverter defibrillator (ICD) provides a survival advantage over antiarrhythmic medications for patients with life-threatening ventricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care providers (e.g., physicians, nurses) can serve as a valuable source of information related to these ICD outcomes. The purpose of this study was to investigate health care provider perceptions regarding: (1) the quality-of-life and psychosocial functioning of their ICD recipients, (2) the concerns or problems reported by ICD recipients, and (3) the degree of provider comfort in managing these concerns. The final sample of health care providers (n = 261) rated ICD recipients' global quality-of-life and psychosocial functioning, and specific concerns about health care, lifestyle, special population adjustment, marital and family adjustment, and emotional well-being. With regard to quality-of-life, health care providers reported that the majority of ICD recipients were functioning better (38%) or about the same (47%) than before implantation. However, health care providers reported that 15% of recipients experienced worse quality-of-life postimplantation. Similarly, health care providers indicated that 10%-20% of ICD recipients experienced worse emotional functioning and strained family relationships. Moreover, issues related to driving, dealing with ICD shocks, and depression were the most common ICD recipient concerns. Significant differences were noted between physicians and nurses/other health care professionals on a wide range of psychosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression and anxiety). These results suggest that routine attention to ICD quality-of-life and psychosocial outcomes is indicated for health care providers who care for ICD recipients.     

Older Adult Surgical Patients: Presentation and Challenges

The age of the population is increasing dramatically, and the age of the surgical population parallels that of the general population. This is occurring at a time when there are fewer health care providers with geriatric expertise in all disciplines.All health care providers must be knowledgeable about the normal changes of aging and must understand communication challenges with older adult patients. Health care providers must understand the specific risks and benefits of surgery and perform a complete individualized preoperative assessment to improve older adult patients' outcomes. AORN J 90 (August 2009) 223-240. © AORN, Inc, 2009.     

Diabetes and managed care: the Lovelace Health System's Episode of Care Program

In order to efficiently manage the care of large populations, the health of that population must be evaluated. People identified with chronic medical disorders, such as diabetes mellitus, should have their disease managed proactively in the most cost-effective manner across the continuum of care. Lovelace Health System has established an Episode of Care disease management program based on the principles of clinical practice improvement. The diabetes program is described as an example of this approach to define and monitor best practice and to decrease variation among providers. This approach optimizes the use of health care resources and improves patient outcomes.     

Predictors of birth outcome among Hispanic immigrant women

Eliminating racial and ethnic disparities in health is a major goal of Healthy People 2010. Health care providers and institutions can address the specialized cultural expectations and needs of Hispanic Americans by assessing acculturation status of the population, an intervening variable in patient compliance, and health outcomes. This article reports on maternal acculturation status and the relationship to birth outcomes of 382 Hispanic pregnant women in the southwest United States. The majority of these women were Mexican-oriented and had healthy pregnancies and healthy birth outcomes. Findings support the hypothesis that traditional Mexican cultural practices serve protective functions for the childbearing woman.     

Meeting the challenge of the new millennium: caring for culturally diverse patients

The world is shrinking, and as a consequence, the United States is changing rapidly. In this new environment, health care providers must navigate a new cultural terrain and develop new skills to provide appropriate care for patients from increasingly diverse backgrounds. The new millennium demographic data of the United States and the essential elements of cultural assessment are necessary to understand how patient care should be approached in an increasingly diverse population.     

Quality health care for adolescents with special health-care needs: issues and clinical implications

Assuring quality health care for the diverse U.S. adolescent population is a subject of growing concern among health-care providers and policy makers. Health-care services and policies must appreciate that experiences of adolescents with special health-care needs include challenges that stretch beyond those unique to their conditions to include relationships with family, friends, and professionals as well as their ability to function in school, clinics, and other settings. This review explores those issues while building upon the six core outcomes delineated in the draft 10-year action plan offered as an accompaniment to the U.S. Department of Health and Human Services' Healthy People 2010 guidelines.     

Optimize patient health by treating literacy and language barriers

More than 90 million Americans have limited literacy skills. Almost two million US residents cannot speak English, and millions more speak it poorly. The stigma of illiteracy or the inability to speak a country's predominant language keep patients from disclosing their limitations. Recognizing these facts is an important first step in improving health education for this vulnerable population. By adapting teaching techniques to patients' special needs, nurses can ensure that patients understand their health problems and plan of care. Statistics dramatically demonstrate the high cost of neglecting these needs. Patients who do not understand their plan of care do not comply with instructions and, therefore, suffer unnecessary complications. Health care providers who can communicate with their patients through multilingual, low literacy patient education materials and with the use of qualified interpreters markedly improve the quality of care for their patients and the resulting outcomes. AORN J 75 (Feb 2002) 280-293.     

Interventions to enhance communication among patients, providers, and families

Whether patient suffering is caused by physical symptoms, unwanted medical intervention, or spiritual crisis, the common pathway to relief is through a provider who is able to elicit these concerns and is equipped to help the patient and family address them. This paper reviews the current state of knowledge in communication at the end of life, organized according to a framework of information gathering, information giving, and relationship building; and then focuses on interventions to enhance communication among patients, providers, and families. Several observations emerge from the existing literature. Patients have highly individualized desires for information and we cannot predict patient preferences. Communication coding methodology has advanced significantly yet the current systems remain poorly understood and largely inaccessible. Physicians and other health care providers do not discuss sufficiently treatment options, quality of life or respond to emotional cues from patients, and there is plenty of room for improvement. On the positive side, we have also learned that physicians and other health care providers can be taught to communicate better through intensive communication courses, and that communication interventions can improve some patient outcomes. Finally, huge gaps remain in our current knowledge, particularly with regard to understanding the relationship between communication style and outcomes. These findings suggest several recommendations. We should create larger and more diverse datasets; improve upon the analysis of recorded communication data; increase our knowledge about patient preferences for information; establish a stronger link between specific communication behaviors and outcomes; and identify more efficient ways to teach providers communication skills.     

Heart transplantation from an ethical perspective

Ethical issues in health care have increased during the past two decades, primarily in response to rapidly evolving advanced technologies. This increase in ethical dilemmas has been most felt by nurses because they are the primary health care providers to whom patients and family members turn for support, counseling, and empathy. Heart transplantation is an area of health care that evokes numerous ethical issues. Ethical beliefs must be examined from the aspects of everyone involved: the patient, family members, and health care providers. Some aspects of the transplantation process also warrant special consideration such as transplantation, lack of a viable support system for patients, and cultural issues. Future projections include a growth in the number and types of ethical dilemmas as technology continues to evolve, populations become more diverse and older, and the health care delivery systems continue to employ a more diverse group of health care providers. This article has attempted to give nurses some insight and guidance about the ethical issues currently being encountered. The article has also included the need for future education of nurses and society.     

The assessment and documentation of language and communication needs in healthcare systems: current practices and future directions for coordinating safe, patient-centered care

Several issues surface when one considers the task of unpacking health disparities and examining features of health care systems that influence patient access, utilization, and outcomes. Although progress has been made in the collection of language data across healthcare systems, little attention has been devoted to examining how a patient's English proficiency and the need for interpretation services are being determined, and how this information is communicated to providers. A lack of a standardized approach to these system-based processes exposes potential limitations in the ability of systems and providers to effectively coordinate care that meets patients' needs and minimizes disparate outcomes. Attention must be given to standardizing these processes to ensure safe, patient-centered care and enable meaningful analyses of access, utilization, and outcomes across linguistically diverse populations. Nurses play a key role in developing and evaluating information systems with which accurate and reliable data can be collected, documented, retrieved, and utilized.     

Foundation Trusts: economics in the 'postmodern hospital'

Foundation Trust Hospitals are community-controlled health care providers which have increased autonomy about how they produce outcomes for the British National Health Service. Although there is a literature on hospital economics it is unclear how these innovative providers will behave, if they have to compete for scarce resources with other hospitals. This paper reviews some of the earlier theories, such as the neoclassical theory of the firm, and discusses their relevance along with 'newer' economic theories such as the transaction costs and evolutionary theory of the firm, plus organizational and human resources theory, to the performance of Foundation Trusts. Much contemporary health care provision is shaped along modernist lines, using scientific endeavour to maximize the impact on health outcomes and technical and social efficiency. However, there is an increasingly postmodern standpoint--critical of modernity--being taken by both patients and hospital staff, to deconstruct processes in the organizations that serve them. Foundation Trusts are postmodern hospitals insomuch as they (to attract scarce resources in a competitive environment), need to marshal the diverse theories of the firm together in order to provide a mass-customized, quality experience, transparently and at least cost--whilst maintaining a stable organizational culture for staff.     

Using IT to improve access,communication, and asthma in African American and Hispanic/Latino Adults: Rationale,design, and methods of a randomized controlled trial

Asthma morbidity is high among inner-city minority adults. Improving access to care and patient–provider communication are believed to be essential for improving outcomes. Access and communication in turn increasingly rely on information technology including features of the Electronic Health Record. Its patient portal offers web-based communication with providers and practices. How patients with limited resources and educational opportunities can benefit from this portal is unclear. In contrast, home visits by community health workers (CHWs) have improved access to care for asthmatic children and promoted caretaker–clinician communication.We describe the planning, design, and methodology of an ongoing randomized controlled trial for 300 adults, predominantly African American and Hispanic/Latino, with uncontrolled asthma recruited from low income urban neighborhoods who are directed to the most convenient internet access and taught to use the portal, with and without home visits from a CHW. The study 1) compares the effects of the 1-year interventions on asthma outcomes (improved asthma control, quality of life; fewer ED visits and hospitalizations for asthma or any cause), 2) evaluates whether communication (portal use) and access (appointments made/kept) mediate the interventions' effects on asthma outcomes, and 3) investigates effect modification by literacy level, primary language, and convenience of internet access. In home visits, CHWs 1) train patients to competency in portal use, 2) enhance care coordination, 3) communicate the complex social circumstances of patients' lives to providers, and 4) compensate for differences in patients' health literacy skills. The practical challenges to design and implementation in the targeted population are presented.     

Durable power of attorney for health care: planning for substitute decision making

Too frequently a relative who is not emotionally close to the patient and who does not know the patient's desires related to health care is authorized to make decisions for the unconscious or incompetent patient, while a non-relative who is intimately involved with the patient and knows the patient's health care desires has no authority to make these decisions. Health care providers must too often stand by helplessly as disinterested or malevolent relatives make these decisions, while caring, competent non-relatives are shut out of the decision-making process. Planning for substitute decision-making can reduce stress and uncertainty for the patient, for the family and for health care providers.     

Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century

Health care is in need of change. Major professional and health care organizations as well as federal agencies and policy-making bodies are emphasizing the importance of evidence-based practice (EBP). Using this problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well designed studies, a clinician's expertise, and patient values and preferences, nurses and other health care providers can provide care that goes beyond the status quo. Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care. Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. This article provides an overview of EBP and offers recommendations for accelerating the adoption of EBP as a culture in education, practice and research.     

“Acute caring” in the emergency department

The aim of this essay was to discuss the ways in which the dynamics of interprofessional communication and collaboration among healthcare providers ultimately affect patient quality of care in the acute setting. Interprofessionalism describes a care model whereby health providers use complementary skills, knowledge and competencies to provide quality care to a group of patients. These interactions are characterized by trust, respect and an understanding of each other's skill and knowledge. At its best, the interprofessional care model has made great strides in the amelioration of patient outcomes, including reduction in negative outcomes, decreased health access needs and increased patient satisfaction. However, challenges with regard to communication and implementation have translated to a steep learning curve for healthcare providers. As such, a new-found emphasis has been placed on interprofessional education for today's healthcare students with the goal of promoting a more efficient and collaborative philosophy for tomorrow's healthcare teams.