Chapter 4 PowerPoint

Communicating with Diverse Patient Groups

1. Communicating with Diverse Patient Groups Chapter 4 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

2. Learning Objectives Recognize how the patient’s perspective in the health care system differs from the perspective of the health care professional. Describe how different cultural perspectives affect the delivery of health care. Explain health disparities related to race and ethnicity. Differentiate sex and gender and define key concepts related to gender identity. Discuss health care and communication best practices when providing health care services to patients of diverse sexual orientations. Discuss health care considerations regarding religious diversity. Discuss health care considerations regarding treatment of patients across the lifespan. Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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.” Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved

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 Copyright © 2020 by Elsevier, Inc. All Rights Reserved