Biases in Care of Persons Who Are Different Than We Are
When replying to two peers, review their experience and offer suggestions to enhance their experience. Use two references each in your response to your peers.
The resources used for your initial post and two separate peer reply posts should all be different resources.
Article # 1 SD
I work on a medical-surgical floor in the heart of Chinatown where the hospital sees a diverse population group on a daily basis. When I get a patient who speaks another language, I already know I have to have patience, as doing assessments and speaking to this patient will take extra time and understanding. A common complication to language barriers according to Gerchow et al (2021) is the increased workload of the nurses which then increases their stress from having to take care of patients with communication barriers. I understand this because there have been times where I have a heavy patient assignment and when a few of your patients do not speak English, it can put a strain on time management. On my unit, we have just gotten these language line solution rolling tablets a few months ago, and in my opinion, they work so much better than the phones we have used in the past. These tablets have a long list of languages available with two options. If I feel like my patient is a visual person and would appreciate seeing who they were talking to, I would use the video option, if not they have the audio option. According to an article by Boylen et al (2020), it was concluded that using an in-person interpreter or a live video interpreter resulted in a shorter time spent in the emergency room when compared to phone interpreters. This was because the patients and families could see the interpreters face and the voices were easier to hear, therefore leading to comfort and decrease stress for the patient.
Positive patient outcomes happen when the healthcare team, patient, and patients’ family are on the same page. Clear communication is key to reaching the goal of positive outcomes. According to Polster (2018), having cultural competency and understand health literacy and health disparities is imperative to providing empathetic care to patients and their families. Polster (2018) goes on to state healthcare facilities need to come up with guidelines that both amplify the experience of the patient and enhance the communication strategies between the healthcare provider and their patients.
A way that I can improve patient outcomes for diverse populations is to speak up. My supervisor recently asked me to join the diversity inclusion committee. One of the goals of this committee is to decrease negative patient outcomes, have more diverse staff hires, and rate some assessment tools the hospital is thinking about implementing. One issue I recently brought up to the committee was the lack of interpreters for specific languages our diverse population speaks. When we call for the language, it is always a hit or miss, and it is more often a miss than a hit. This causes a delay in care when communication is needed. The committee has this issue on their radar and are working with the interpreter service to see what other options are available. I will be eager to see what solutions they have in mind at our next meeting.
References:
Boylen, S., Cherian, S., Gill, F. J., Leslie, G. D., & Wilson, S. (2020). Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evidence Synthesis, 18(7), 1360–1388. https://doi.org/10.11124/JBISRIR-D-19-00300
Gerchow, L., Burka, L. R., Miner, S., & Squires, A. (2021). Language barriers between nurses and patients: A scoping review. Patient Education and Counseling, 104(3), 534–553. https://doi.org/10.1016/j.pec.2020.09.017
Polster, D. S. (2018). Confronting barriers to improve healthcare literacy and cultural competency in disparate populations. Nursing, 48(12), 28–33. https://doi.org/10.1097/01.NURSE.0000547717.61986.25
Article # 2 TG
Working in labor and delivery we had our fair share of patients with communication barriers. Typically we would utilize the language line to facilitate communication. For patients with hearing deficits we would utilize a sign language interpreter. We attempted to use the computer program in which a sign language interpreter would be on a computer monitor and sign with the patient. Unfortunately, that technology is not always available in every healthcare environment. In fact, according to Olson and Swabey (2017) there is still a large amount of work to be done to properly facilitate communication between deaf patients and their healthcare providers. During the height of the COVID-19 pandemic, working with interpreters became increasingly difficult. Families were not allow to be in birthing rooms to assist in translation, and we were also not allowed to utilize third party assistance for sign language.
I remember a situation in which we had a patient and her husband that were admitted for induction of labor. They were both deaf, but very skilled at reading lips. However, due to the mask requirement, we were not able to utilize the communication method. It was incredibly frustrating to the nursing staff, the patient, and her husband. Many nurses simply refused to take her as a patient assignment due to the added difficulty in caring for her. This bias shown by the nurses added to the frustration of the patient and her husband. While they were not directly aware of the situation, it was apparent that many nurses were frustrated with the lack of ability to communicate. Luckily, one nurse had the idea of modifying her mask to allow for the patient and her husband to be able to see her lips while speaking, but also while maintaining needed protection against virus transmission. This allowed the nurses and doctors to safely and holistically care for the patient during her labor and delivery. All it took was for one nurse to set aside her bias and think of an innovative way to care for the patient and her husband. Obstacles such as the inability or refusal to communicate with deaf patients can lead to poor outcomes and decrease their overall health literacy (McKee et al., 2015). By taking time to set aside any bias the nurse may have had, she discovered and implemented a solution that was able to aid the patient and her husband in communication with their healthcare team through the entirety of their admission. They were able to understand and communicate their needs when caring for their newborn prior to discharge. Providing competent care to patients with communication barriers allows for a more satisfying experience for the patient and the healthcare provider (Kuenburg, Fellinger, & Fellinger, 2016). Nurses must strive to set aside bias and frustration and treat every patient with competent, compassionate care. I was proud to work alongside a nurse with such innovation that was able to improve the patient and her husband’s delivery experience.
References
Kuenburg, A., Fellinger, P., & Fellinger, J. (2015). Health care access among deaf people. Journal of Deaf Studies and Deaf Education, 21(1), 1–10. https://doi.org/10.1093/deafed/env042
McKee, M. M., Paasche-Orlow, M. K., Winters, P. C., Fiscella, K., Zazove, P., Sen, A., & Pearson, T. (2015). Assessing health literacy in deaf american sign language users. Journal of Health Communication, 20(sup2), 92–100. https://doi.org/10.1080/10810730.2015.1066468
Olson, A. M., & Swabey, L. (2017). Communication access for deaf people in healthcare settings: Understanding the work of American sign language interpreters. Journal for Healthcare Quality, 39(4), 191–199. https://doi.org/10.1097/jhq.0000000000000038
