C.L.U.E.S. Culture and Language: Using Effective Strategies in Medical Settings Jody Prysock, MS, CI
Goals • Examine, explore and discuss challenges • Identify tips, strategies and techniques • Think about how to create a “tool box”
• Practice applying skills with scenarios presented
Pre-requisites • Think critically • Be self-aware • Observe keenly • Be open-minded • Resist complacency
Ground Rules • Actively “listen” to others. • Respect each other’s comments/opinions. • Maintain confidentiality – do not use names, places or other identifying. information. • Apply all life experience and knowledge to practice.
When does the assignment begin? When we accept the job! What do we think we need to know? Is there prep work involved? How often do we “wing it”? What questions do we ask ourselves? What questions do we ask the referral source? • Do we focus mostly on terminology/language/context? • • • • • •
Demand-Control Schema “Challenges (demands) presented by work tasks in relation to the resources (controls or decision latitude) that workers bring to bear in response to job demands.� Dean and Pollard (2001)
D-C Schema • Environmental demands • Interpersonal demands • Paralinguistic demands • Intrapersonal demands
Environmental Demands • • • • • •
Assignment setting Understanding roles Specialized terminology Space limitations Temperature or weather Odors
Interpersonal Demands • • • • • • •
Interaction of those involved Cultural differences Power differences and dynamics Fund of information (Pollard 1988) Perceptions Preconceptions Goals of the “consumers”
Paralinguistic Demands • Expressive communication of both deaf and hearing consumers • Clarify of material accents, mumbling, lazy signing, etc.
Interpersonal Demands • Physiological state • Psychological state Hunger Fatigue Thoughts Feelings
Culture Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
Cultures Patient
Provider
Interpreter
Cultural Competence Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. Based on Cross, T., Bazron, B., Dennis K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care Volume I. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.
Ethics • The discipline dealing with what is good and bad and with moral duty and obligation; • Decisions, choices, and actions we make that reflect and enact our values; • A set of moral principles or values; • A theory or system of moral values; • A guiding philosophy "Creating a Workable Company Code of Conduct," 2003, Ethics Resource Center
The “Work”
Relationships • • • • • •
How are they established? Why are they important? Who does the “building”? What part do interpreters play? Does it depend? High stakes? How do we decide?
Transference and Countertransference Patient
Provider
Interpreter
What do we know about providers? • • • • • • •
tight schedules culturally bound beliefs/practices healthy egos (just sayin’) trained to diagnose (dx) and treat (tx) unaccustomed to interpreters unfamiliar with deaf and hoh people a life outside of this encounter
What do we know about patients? • • • • • • • •
anxious scared intimidated vulnerable sleep deprived (maybe) experiencing pain health illiterate a life outside of this encounter
What do we know about the interpreter?
Expectations that: • all dialogue/information is clear • all parties understand each other • the assignment runs on time • he/she is dressed appropriately • personal life will not interfere with assignment • the next assignment is less difficult than it was last week • there will be time for lunch • a life outside of this encounter
What is the ultimate goal?
• To ensure effective communication between the healthcare team and the patient
• How? by fostering the therapeutic alliance by providing culturally and linguistically appropriate services Effective communication is a right, not a privilege, and can be a matter of life or death.
Questions and Comments
SCENARIOS • Identify and examine possible variables for each scenario • Discuss options • Explore implications of all decisions • Review what could be done differently next time
SCENARIO #1 Inpatient Hospital Unit • Received a call from an agency to go to an inpatient unit at a large academic medical center • Provided patient name, unit, and bed number
• No additional information is given
SCENARIO #1 • Enter the medical center, ask security for directions which are unclear • Arrive on the unit with a few minutes to spare • Try to check in at the nurse’s station No one makes eye contact
SCENARIO #2 Inpatient Substance Abuse Unit • Called by agency to provide services
• Upon arrival, acclimated to the milieu by nurse manager • Talk briefly with the patient • Interpret for a group • Sit at nurse’s station until needed
SCENARIO #3 Sub-Acute Rehabilitation • Discharge planning meeting • Patient, patient’s mother, father, brother, and uncle present • Family from another country • Deaf = disability • Patient has linguistic deficits • ASL is patient’s 3rd language
SCENARIO #4: Private Doctor’s Office • Deaf-blind patient has doctor’s appointment to review MRI results. • Doctor has treated this patient for the past two years • The interpreter has provided services for this doctor and patient on several occasions • Patient communicates using tactile sign language
SCENARIO #4 • Patient – sitting on examination table • Interpreter - standing next to patient • Doctor - sitting at computer with back to patient and interpreter • Directed to patient: “Tell her I’m just bringing up her MRI results.” • Directed to interpreter: “So if you look over here, you can see this is where her tumor is.”
SCENARIO #5 Bedside
• Interpreter and nurse walk into patient’s room • Nurse lowers guard rail and raises bed preparing for exam • Nurse receives a phone call regarding another patient • Proceeds to state patient’s name and diagnostic information • Indicates interpreter should stop interpreting
SCENARIO #5 • Nurse ends phone call and resumes assessment with patient • Nurse is called again, excuses herself, and leaves the room • Guard rails are still lowered and bed is still raised • Interpreter is left alone in room with patient
SCENARIO #6 Family Member as “Interpreter” • Patient refuses an interpreter • Insists that daughter interpret • Hospital policy is to use a qualified interpreter • Interpreter instructed to be present during discussion with healthcare team • Daughter is omitting crucial information and not interpreting accurately
SCENARIO #7 SLP Session • Patient suffered a stroke • Expressive language significantly impaired • Appears to have intact receptive skills • Speech/language pathologist assesses patient
SCENARIO #7 • Patient's wife is deaf • Patient's adult children sign fluently • SLP knows some sign and excuses the interpreter • Patient's family insists on interpreter be present • SLP begins working with patient on verbal expression
SCENARIO #8 Child in Outpatient Visit • Parents (2 dads) are hearing • 6 year old daughter is deaf • Patient has complications as a result of CI • Resident checks on patient just as interpreter is leaving • Parents start asking questions • Patient is clearly not understanding
SCENARIO #9 Deaf Patient in Emergency Room Patient arrives with a case manager ER is very busy Patient is not a good historian CM needs to leave SW tries to get in touch with group home – unsuccessful • Interpreter has a prior commitment • • • • •
SCENARIO #10 Informed Consent • Patient is scheduled for emergency surgery • Interpreter arrives and is instructed to “translate” the informed consent • Suggests the surgeon go through the consent and explain to the patient • Patient agrees and then asks the interpreter to explain what the surgeon has just said
Questions and Comments
Thank You!