Intro
One of the most vivid memories I had and will always carry with me as a nurse is when I used to volunteer at an organization called Bristol Hospice, which is design to provide psychosocial needs, and promote quality care to patients who has a few months left to live. Clients who are in the hospice care usually have friends and family to come visit them while others do not. As a volunteer, this is where I come in to become one of their extended families (don't know how to say it should I say close friends? Relatives? Or its fine the way it is?) by providing them a stimulating environment such as activities that they love to do or simply just listening and talking to them. While having the privilege to provide companionship to my patients, I also had the opportunity to witness the interaction between the professional nurse and the ones that they caring for. I did find few RN's who are insanely compassionate about their profession but most of the time I have encountered nurses who lack one of the six core competencies, which are patient-centered care, team work and collaboration, evidence based practice, quality improvement, safety, and informatics which are all under the category of Quality and Safety Education for Nurses (QSEN) that is identified by the Institute of Medicine. One of the QSEN that stands out the most is patient-centered because throughout my volunteer work at hospice facility, I noticed that some nurses did not know how to connect well with their patients. In order to achieve patient-centered care, undergrad nurses need to be culturally competent by gaining the appropriate knowledge, skills, and attitude in order to recognize our patient's values and health beliefs.
Knowledge
Besides textbooks information on how to become an RN, pre-nurses significantly need to gain the knowledge on how to be culturally competent in order to increase their patient's life span and reduce health disparities. This is because "if [health care professionals] don't understand the person's cultural background, they will have difficulty engaging with that person, whether it's on the telephone or face-to-face, and they might not be able to help the person modify his or her behavior or adhere to the treatment plan (Case Management Advisor, 2011)". It's very important for nurses to learn how to culturally engage with patients so that they could provide intervention that that would accommodate to their lifestyles.
A perfect example is the organization that I'm currently volunteering which is the Pilipino Senior Resource Center (PSRC) that is a non-profit organization dedicated to help the minority by providing them with free health screening, translation, navigational services, and education on how to live a healthy lifestyle. PSRC main goal is to provide a strong bridge between the health care provider and the minority to minimize the health disparities in order to receive a positive outcome of the patient's health status. We usually accompany our clients to their clinician and help translate health information in order to enhance the communication skills to his or her own health care provider.
During our visitation, the clinician wondered why the client's symptoms have gotten worse even though the provider has been prescribing the appropriate medication to reduce the condition. This is because my client who was Filipino did not believe in taking medication. He believes that taking pills would only destroy his mind and spirit. Since I grow up in the Philippines, I realized that my client has the same belief as those people back in my country who only depended on herb medicine. Because of the lack of cultural awareness, and communication, the provider still insists the patient on taking the pills. As a result, the clinician was not able to see a healthy status from my client. Instead of treating the symptom, his condition has gotten worse.
In order to meet the demand of patient-centered care, health care provider need to "recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient preferences, values, and needs (Cherry & Jacob, 2011)". The provider should have known that not all treatment suit to every patient need. The physician should have addressed that the patient's belief by providing him other treatment such as educating him on how to use and letting him know which kind of herb medicine the patient should be taking. This way the patient could feel a strong connection with their health care providers because they are simply more than just a human being. On the other hand, clinicians who look through the patient's health culturally are able to recommend treatments that will have a huge influence for obtaining preventive care.
Skills
Even though PSRC is making a difference in the health care industry by reducing health disparities, there is still a huge problem of reaching out to other patients. This is one of the main goals of Health People 2020 which is to reduce health disparities among Americans. One of them is to reduce cultural obstacles between the patient and nurse. Just like the experience I had at the hospice care, one nurse was lacking the knowledge on how to culturally engage with their patient whose ethnicity was Asian suffering from diabetes. For example, the RN wanted to take away the rice from the patient's diet in order to reduce his blood sugar. The patient then started to retaliate against the nurse by showing an aggressive behavior and spitting all the medicines that was being giving to him.
As I witness this event, I learned to analyze the nurse's mistake that also helped me think critically by finding a solution to this problem. The nurse should have been aware that the white rice has been a big part of the patient's diet. Instead of removing the white rice immediately, she should have explained before proceeding with her action. She could have asked the patient if it was alright to substitute the white rice with brown rice. There are many solutions to this event because when there's a problem there is always an answer. Thinking critically and independently is one of the skills that nurses need to achieve in order to attain the highest level of health for all people.
Attitude
Besides the knowledge, and skills that the health professionals need to attain, they also need to have the right attitude in order to achieve patient-centered care. When I used to volunteer at the hospice care, I could sense that some of the nurses were not aware of the facility's main goal. Our focus at Bristol Hospice is to empower our patients to make their own choices regarding care and assistance. I'm sure that most of the patients I have encountered want a meaningful life before they pass away. They don't want a nurse who is taking care of them that's always cranky, bad-tempered and pessimistic. They want a health provider who is able see though their eyes and acknowledge what's important to them.
An example is when I noticed the patient's daily routine at the hospice care. Every day they would wake up, eat, watch the show the price is right, take their medication and go to bed. This happens all the time whenever I come visit my patients. I barely saw any nurses who actually had the time to sit down to listen and talk with their patient. Believe or not, having a small talk with them really makes a difference because most they have not seen their family for a long time. We are the one who will fill in that gap so that our patients see us "as their advocates, with their best interests at heart. If a patient trusts the nurse, the patient will be more apt to reveal important information in the patient history, allowing more accurate assessments and treatment plans (Olshansky, 2011)". Besides just treating the symptoms, every RN should acknowledge the patient's mind, soul, and spirit because everyone's values matter.
Conclusion
For nurses to become culturally competent, we need to start educating undergrad nurses on how to socially and culturally engage with others. In order to gain the knowledge, skills, and attitude on how to be culturally competent, pre-nurses should be required to finish a certain amount of volunteer hours till their senior years. Besides their clinical work, service learning should be accomplished outside the campus in order to educate and exposed pre-nurses on how to culturally engage with other ethnicity. These experiences can be acquired at a variety of places such as the nursing homes, hospice care, hospitals, or small private clinics.
The benefit of pushing undergrad nurses to commit of doing volunteer work is that it gives the experience and valuable lesson on what it takes to achieve patient-centered care. Throughout their service learning, student will get to endure and learn different values from all kinds' patients out there. As you mentioned in class, everything is interconnected which also a perfect timing to gather all the class room base knowledge and apply it in their volunteer work. Here they will witness some nurses who will have the lack of knowledge, attitude, and skills and they will think for themselves on how to become a better nurse. Learning from others mistake is one way to achieve patient-centered care.
One of the most vivid memories I had and will always carry with me as a nurse is when I used to volunteer at an organization called Bristol Hospice, which is design to provide psychosocial needs, and promote quality care to patients who has a few months left to live. Clients who are in the hospice care usually have friends and family to come visit them while others do not. As a volunteer, this is where I come in to become one of their extended families (don't know how to say it should I say close friends? Relatives? Or its fine the way it is?) by providing them a stimulating environment such as activities that they love to do or simply just listening and talking to them. While having the privilege to provide companionship to my patients, I also had the opportunity to witness the interaction between the professional nurse and the ones that they caring for. I did find few RN's who are insanely compassionate about their profession but most of the time I have encountered nurses who lack one of the six core competencies, which are patient-centered care, team work and collaboration, evidence based practice, quality improvement, safety, and informatics which are all under the category of Quality and Safety Education for Nurses (QSEN) that is identified by the Institute of Medicine. One of the QSEN that stands out the most is patient-centered because throughout my volunteer work at hospice facility, I noticed that some nurses did not know how to connect well with their patients. In order to achieve patient-centered care, undergrad nurses need to be culturally competent by gaining the appropriate knowledge, skills, and attitude in order to recognize our patient's values and health beliefs.
Knowledge
Besides textbooks information on how to become an RN, pre-nurses significantly need to gain the knowledge on how to be culturally competent in order to increase their patient's life span and reduce health disparities. This is because "if [health care professionals] don't understand the person's cultural background, they will have difficulty engaging with that person, whether it's on the telephone or face-to-face, and they might not be able to help the person modify his or her behavior or adhere to the treatment plan (Case Management Advisor, 2011)". It's very important for nurses to learn how to culturally engage with patients so that they could provide intervention that that would accommodate to their lifestyles.
A perfect example is the organization that I'm currently volunteering which is the Pilipino Senior Resource Center (PSRC) that is a non-profit organization dedicated to help the minority by providing them with free health screening, translation, navigational services, and education on how to live a healthy lifestyle. PSRC main goal is to provide a strong bridge between the health care provider and the minority to minimize the health disparities in order to receive a positive outcome of the patient's health status. We usually accompany our clients to their clinician and help translate health information in order to enhance the communication skills to his or her own health care provider.
During our visitation, the clinician wondered why the client's symptoms have gotten worse even though the provider has been prescribing the appropriate medication to reduce the condition. This is because my client who was Filipino did not believe in taking medication. He believes that taking pills would only destroy his mind and spirit. Since I grow up in the Philippines, I realized that my client has the same belief as those people back in my country who only depended on herb medicine. Because of the lack of cultural awareness, and communication, the provider still insists the patient on taking the pills. As a result, the clinician was not able to see a healthy status from my client. Instead of treating the symptom, his condition has gotten worse.
In order to meet the demand of patient-centered care, health care provider need to "recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient preferences, values, and needs (Cherry & Jacob, 2011)". The provider should have known that not all treatment suit to every patient need. The physician should have addressed that the patient's belief by providing him other treatment such as educating him on how to use and letting him know which kind of herb medicine the patient should be taking. This way the patient could feel a strong connection with their health care providers because they are simply more than just a human being. On the other hand, clinicians who look through the patient's health culturally are able to recommend treatments that will have a huge influence for obtaining preventive care.
Skills
Even though PSRC is making a difference in the health care industry by reducing health disparities, there is still a huge problem of reaching out to other patients. This is one of the main goals of Health People 2020 which is to reduce health disparities among Americans. One of them is to reduce cultural obstacles between the patient and nurse. Just like the experience I had at the hospice care, one nurse was lacking the knowledge on how to culturally engage with their patient whose ethnicity was Asian suffering from diabetes. For example, the RN wanted to take away the rice from the patient's diet in order to reduce his blood sugar. The patient then started to retaliate against the nurse by showing an aggressive behavior and spitting all the medicines that was being giving to him.
As I witness this event, I learned to analyze the nurse's mistake that also helped me think critically by finding a solution to this problem. The nurse should have been aware that the white rice has been a big part of the patient's diet. Instead of removing the white rice immediately, she should have explained before proceeding with her action. She could have asked the patient if it was alright to substitute the white rice with brown rice. There are many solutions to this event because when there's a problem there is always an answer. Thinking critically and independently is one of the skills that nurses need to achieve in order to attain the highest level of health for all people.
Attitude
Besides the knowledge, and skills that the health professionals need to attain, they also need to have the right attitude in order to achieve patient-centered care. When I used to volunteer at the hospice care, I could sense that some of the nurses were not aware of the facility's main goal. Our focus at Bristol Hospice is to empower our patients to make their own choices regarding care and assistance. I'm sure that most of the patients I have encountered want a meaningful life before they pass away. They don't want a nurse who is taking care of them that's always cranky, bad-tempered and pessimistic. They want a health provider who is able see though their eyes and acknowledge what's important to them.
An example is when I noticed the patient's daily routine at the hospice care. Every day they would wake up, eat, watch the show the price is right, take their medication and go to bed. This happens all the time whenever I come visit my patients. I barely saw any nurses who actually had the time to sit down to listen and talk with their patient. Believe or not, having a small talk with them really makes a difference because most they have not seen their family for a long time. We are the one who will fill in that gap so that our patients see us "as their advocates, with their best interests at heart. If a patient trusts the nurse, the patient will be more apt to reveal important information in the patient history, allowing more accurate assessments and treatment plans (Olshansky, 2011)". Besides just treating the symptoms, every RN should acknowledge the patient's mind, soul, and spirit because everyone's values matter.
Conclusion
For nurses to become culturally competent, we need to start educating undergrad nurses on how to socially and culturally engage with others. In order to gain the knowledge, skills, and attitude on how to be culturally competent, pre-nurses should be required to finish a certain amount of volunteer hours till their senior years. Besides their clinical work, service learning should be accomplished outside the campus in order to educate and exposed pre-nurses on how to culturally engage with other ethnicity. These experiences can be acquired at a variety of places such as the nursing homes, hospice care, hospitals, or small private clinics.
The benefit of pushing undergrad nurses to commit of doing volunteer work is that it gives the experience and valuable lesson on what it takes to achieve patient-centered care. Throughout their service learning, student will get to endure and learn different values from all kinds' patients out there. As you mentioned in class, everything is interconnected which also a perfect timing to gather all the class room base knowledge and apply it in their volunteer work. Here they will witness some nurses who will have the lack of knowledge, attitude, and skills and they will think for themselves on how to become a better nurse. Learning from others mistake is one way to achieve patient-centered care.
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