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- 1. Communicating with Diverse Patient Groups CHAPTER 4
- 2. Learning Objectives 1. Recognize how the patient’s perspective in the health care system differs from the perspective of the health care professional. 2. Describe how different cultural perspectives affect the delivery of health care. 3. Explain health disparities related to race and ethnicity. 4. Differentiate sex and gender and define key concepts related to gender identity. 5. Discuss health care and communication best practices when providing health care services to patients of diverse sexual orientations. 6. Discuss health care considerations regarding religious diversity. 7. Discuss health care considerations regarding treatment of patients across the lifespan.
- 3. Introduction • Communication is vital with all types of people • May be more challenging with people who are different from ourselves • Many forms of diversity exist • age, race, sex, sexual orientation, gender, gender identity, ability, socioeconomic status, and religion, and more • Awareness of pt diversity yields better communication • Recognize similarities as well as differences • Pause and consider any personal biases
- 4. The Diversity of the Patient Experience • Don’t lose sight of the pt’s perspective • Health care is complex, stressful, can be scary • Routine activities for the HCP are extraordinary for the patient • Take time to tell your patients and clients what you are doing and why • Build trust • Be mindful in those busy moments
- 5. Awareness of Cultural Biases (1 of 3) • A culture is the set of acceptable behaviors, beliefs and traits of a racial, religious or social group • A person’s culture influences how they see the world, including health and wellness • HCP must be open and accepting of these differences • Cultural imposition – when a person or group believes others should adhere to their beliefs • When HCP impose personal beliefs on pts, they decrease the chance of a successful interaction
- 6. Awareness of Cultural Biases (2 of 3) • Cultural imposition leads to health disparities • Healthy People 2020 • U.S. federal government initiative • Sets 10-year goals and objectives • Framework promotes wellbeing • Goal to eliminate unequal outcomes among disadvantaged populations • Tracks rates of health in relation to race and ethnicity
- 7. Awareness of Cultural Biases (3 of 3) • Cultural beliefs affect how pts perceive health care • How they relate to pain, illness and injuries • Traditional medicine versus natural healers • Whether to follow health care directives • When you think of your own culture objectively, you may become aware of how alike we all are • Respect is developed through awareness • Treating all pts all equally doesn’t mean all the same
- 8. Personal Biases • A bias is a tendency to favor one way of thinking • Prejudice means prejudging a person or group before facts and circumstances are known • Inability to recognize your biases leads to poor communication and is an obstacle to good pt care • You do not have to agree with every view of your pt • You do have to be respectful of differences • Be honest, flexible and kind without exception
- 9. Ethnic and Racial Diversity (1 of 2) • Race – a shared ancestry, biological, genetic traits • Ethnicity – common language, history and traditions • Racial and ethnic minorities have less access to health care, primarily owing to lack of health insurance • Without insurance persons delay or forego care • More likely to visit ED for treatment, even for minor health problems • EDs are required by law to assess and stabilize • ED not equipped with records, no follow-ups • Affordable Care Act – reduced number of uninsured • Diverse pts still have difficulty with appointments, communicating, obtaining prescription medicine
- 10. Ethnic and Racial Diversity (2 of 2) • HIV affects African Americans at higher rates • Nearly half of new HIV diagnoses • Many risk factors lead to higher rates • Cardiovascular disease (CVD) in minorities • High blood pressure and risk of stroke, CVD more prevalent among African Americans • Affects 15.4% of the American Indian and Alaskan Native population • Diabetes • African Americans & Hispanics are 70% higher risk • In turn, more amputations, blindness, kidney failure
- 11. Overcoming a Language Barrier • By law, non-English speakers must receive same services as English speakers • Providers must offer translation at no cost • Forms and education materials translated • Signage in alternate languages • Use interpreters to facilitate communication
- 12. Diversity in Sex, Gender and Gender Identity (1 of 3) • Sex is a biological status, while gender is a psychosocial condition influenced by perception • Gender identity describes how one identifies their sex • Can be the same as their sex at birth, or different • Transgender – gender identity differs from sex at birth • Cisgender- gender identity aligns with sex at birth • Transgender identity is not dependent on medical procedures or physical appearance • Transition – The process of altering one’s sex
- 13. Diversity in Sex, Gender and Gender Identity (2 of 3) • Non-binary – not exclusively masculine of feminine • identify with both or neither genders, a third gender, or oscillate among genders • Genderqueer – identity doesn’t fit into either male or female • Both genders at once, or a third gender • Genderfluid – doesn’t confine identity to one gender • Presents as masculine, feminine, neither, or both • Be respectful to all pts • Ask for and use preferred gender pronouns
- 14. Diversity in Sex, Gender and Gender Identity (3 of 3) • Ask: “What are you pronouns?” • If they don’t wish to share, just use their name • Don’t assume pronouns based on appearance • Use singular “they/them” pronouns if unsure • Introduce yourself with you own pronouns • “My name is Ben, I use the pronouns he/him/his.” • If you make a mistake, a simple apology will help • “I apologize for using the wrong pronouns/terms. I did not mean to disrespect you.”
- 15. Sexual Orientation • Sexual orientation is based on who one is attracted to, romantically, emotionally, and sexually • Includes the sociocultural environment associated with this attraction • Heterosexual • Homosexual • Bisexual • Asexual - feeling no sexual attraction
- 16. Gay, Lesbian and Bisexual Patients • Typically seek routine and preventive care less often • May avoid care and delayed or missed diagnoses owing to overt or perceived negative attitudes of HCPs • Higher rates of substance abuse, depression, anxiety • Gay males are at the highest risk for HIV • Lesbian women less likely to have health insurance • Offer a welcome atmosphere • Pride flag shows all types of pts are welcome • Listen, ask right questions, and avoid assumptions • Provide info on free/discounted health services
- 17. Religious Diversity • Religion often influences how pts react to illness, pain • Beliefs may affect medical care • Be non-judgmental • Some traditions concerned with modesty • Dietary restrictions • Fasting days or times • Food restrictions (Table 4-2) • Prayer at certain times • Take care to avoid disturbing your pt • Ask pts how you can accommodate their beliefs during their stay
- 18. Diversity in Age • We are constantly adjusting our communication style based on different age groups • Infants, toddlers, children and adolescents all have unique strategies of communication • Jean Piaget’s theory of intellectual development based on the chronological age of a child • Four intellectual stages (sensorimotor, preoperational, concrete operational, formal operational) • Each stage requires different communication approach
- 19. Communicating with Children (1 of 2) • Sensorimotor stage – birth to 2 years old • Physical growth and cognitive development • Begin to acquire physical and language skills • Care for these pts in a gentle manner • Preoperational stage – 2 to 7 years old • Self-centered • Learn from peers and think concretely • Pt of this age may require comforting • Concrete operational stage – 7 to 11 years old • Understanding that people and things change • Logical thinking • Pt of this age understands your role and actions
- 20. Communicating with Children (2 of 2) • Formal operational stage – 11 to 15 years old • Begins abstract thinking • Reasoning skills and can consider other POVs • Pt may be very interested, include them as partner • Be patient, ill children may regress to earlier stages • Children are unique and may not fit in developmental stage relative to their chronological age • Adaptation to communication style is crucial
- 21. Communicating with Adults • Adults are not a single group • Age and developmental decline are considered • Younger and older adults may be treated differently • As with children, you must be able to adapt to the appropriate communication style
- 22. Communicating with Older Adults • Persons aged 65 and older • 23% of this group are racial and ethnic minorities • Population of older adults projected to double by 2060 • 49.2 million to 98 million • People at age 65 can expect to live about 20 more years • Generally, need for health care increases with age • 20% report 10+ health care visits last 12 months • Older adults may have communication barriers: • Vision • Hearing • Memory
Editor's Notes
- The flow of patients in the facility, the array of clinical and administrative personnel, and the details of billing and scheduling processes are second nature to the health care professionals who work in this environment, but can be daunting to many patients effective communication can improve the patient’s experience, shorten length of stay, reduce readmissions, and decrease health care costs
- not every patient will understand technical jargon, and some may not even understand English. We have to consider each patient individually, and explain what we are doing using terms they can understand. Treating all your patients equally doesn’t mean treating them all the same
- The census recognizes six different racial categories: White Black or African American American Indian or Alaskan Native Asian Native Hawaiian or other Pacific Islander U.S. Census survey respondents may also report their race as “other,” or select multiple races. The census categorizes ethnicity as “Hispanic or Latino,” and “Not Hispanic or Latino.” Hispanics and Latinos can be of any race Title VI of the Civil Rights Act of 1964 is a federal law that protects people from discrimination based on their race, color, or national origin. In health care, any facility or program that receives federal funds, such as Medicare, must provide the same service in the same way to everyone.
- Risk factors leading to higher HIV infections in African Americans: Tendency to choose partners in same community higher rates of other sexually transmitted diseases limited access to quality health care lower income stigma against those with HIV and lack of access to health care American Indians and Alaskan Natives are also disproportionately affected by heart disease. Approximately 15.4% of this population has been diagnosed with coronary artery disease, angina, heart attack, or another heart condition, while the rate among Blacks is 10.1%, and is 11.0% among whites (Blackwell & Villaroel, 2018)
- While the size of the transgender population is not well-known, it is estimated that there are about 1.4 million transgendered adults living in the United States. This population may present with health care problems unique to their transgender status Many transgender people are prescribed hormones by their health care professionals to align their bodies with their gender identity, and some people will also undergo surgery for this purpose Transitioning: There are various steps and therapies within the transition process, and the decisions to embark on any step or therapy is a very personal and emotional decision. An individual may change their name or begin to dress differently. An individual may also seek medical interventions, such as hormone therapy or confirmation surgery. In the past we referred to a person undergoing a “sex change,” but now refer to this as a person “in transition.”
- Table 4-1 “Gender Pronouns” Singular they/them: Nominative Oblique Possessive Determiner Possessive Pronoun Reflexive Example they (singular) them their theirs themself They express themself.
- -The term sexual orientation describes more than just the gender with which a person has sex; it encompasses who a person is attracted to romantically, emotionally and sexually, and the sociocultural environment associated with this attraction. -A person has a sexual orientation even if they have not had sex.
- Modesty concerns: When hygiene therapies or procedures requires disrobing or partial nudity, patients may request that a health care professional of the same sex provide that care. Your institution may have policies regarding how these personnel decisions are made.
- Sensorimotor stage milestones: Sucking and rooting (the ability to bring things to the mouth) Eye/hand (seeing an object and reaching for it) Discovering self-rewarding activities (thumb-sucking, playing with a favorite object) Anticipating (“I see the bottle. It must be for me.”) Exploring (“If I pull this lamp cord, I wonder what will happen.”) Verbal skills also develop during this stage as children learn to communicate and interact with caregivers Preoperational stage milestones: Engage in role playing, often pretending to a be mom, a dad, or a teacher Enjoy pretending, and engage in symbolic play Develop a memory, understand past and future Tend to be egocentric and struggle to see things from the perspective of others Concrete operational stage details: They understand abstract concepts and are beginning to exercise self-determination (autonomy). Peer groups frequently are more influential than family at this age. In addition, children in the concrete operational stage: Develop logical thinking skills, although thinking remains very concrete. Begins using inductive logic, moving from specific information to a general principle
- Formal operational stage: Begin to develop abstract thinking skills Can use reasoning skills to answer hypothetical problems Consider ethical and moral issues from points of view other than their own Develope deductive reasoning skills, moving from the general principles to the specific instances. They may explore their illness on the internet, and attempt to act as experts on how they wish to be cared for. Getting buy-in from your patient will increase adherence to the plan of care All stages: Sick children can regress back to an earlier developmental stage. For example, some children who are potty-trained may revert back to bedwetting or may have frequent accidents, requiring the use of diapers. Some children who had been testing their independence prior to an injury or illness may suddenly become more dependent on a parent or caretaker.