Cultural Aspects Of Care Research Articles

Educating Psychiatry Residents About Cultural Aspects of Care: A Qualitative Study of Approaches Used by U.S. Expert Faculty

Educating Psychiatry Residents About Cultural Aspects of Care: A Qualitative Study of Approaches Used by U.S. Expert Faculty

Educating Psychiatry Residents About Cultural Aspects of Care: A Qualitative Study of Approaches Used by U.S. Expert Faculty

Almost no literature compares current approaches to teaching cultural issues across U.S. psychiatry residency programs; the authors addressed this comparison. The authors administered semistructured interviews of 20 instructors with substantial experience in the teaching of cultural issues in U.S. psychiatry residency programs, regarding the content, teaching techniques, institutional context, and evaluation of their curricula over time. Approaches varied according to the local populations served and the background of the instructors, all of whom were either cross-trained in social sciences and humanities or were themselves ethnic, racial, or sexual minorities. Common themes emerged, including the use of experiential approaches, the lack of integration of cultural issues into clinical supervision or courses on other topics, and the absence of formal course evaluation. Findings indicate a need for integration of cultural concepts into a variety of settings throughout residency, for development of faculty who are cross-trained in social sciences and humanities, and for curriculum-evaluation strategies.

Pediatric palliative care for youth with HIV/AIDS: systematic review of the literature

Improvement in treatment has led to decreased death in youth with human immunodeficiency virus (HIV) in developed countries. Despite this, youth with HIV are still at risk for increased mortality and morbidity compared with their uninfected counterparts. In developing countries, high numbers of youth die from acquired immune deficiency syndrome (AIDS)-related illnesses due to lack of access to consistent antiretroviral treatment. As a result, pediatric palliative care is a relevant topic for those providing care to youth with HIV. A systematic review was conducted to gather information regarding the status of the literature related to pediatric palliative care and medical decision-making for youth with HIV. The relevant literature published between January 2002 and June 2012 was identified through searches conducted using PubMed, CINAHL, Scopus, and PSYCInfo databases and a series of key words. Articles were reviewed by thematic analysis using the pillars of palliative care set out by the National Consensus Project. Twenty-one articles were retained after review and are summarized by theme. In general, few empirically based studies evaluating palliative care and medical decision-making in youth with HIV were identified. Articles identified focused primarily on physical aspects of care, with less attention paid to psychological, social, ethical, and cultural aspects of care. We recommend that future research focuses on broadening the evaluation of pediatric palliative care among youth with HIV by directly evaluating the psychological, social, ethical, and cultural aspects of care and investigating the needs of all involved stakeholders.

Compliance of state registered nurses to nursing standards during practice in tertiary facilities in Malawi

The aim of this study was to describe the quality of practice offered by nurses to patients who underwent surgical incision into the abdomen (post-laparotomy) at tertiary hospitals (Kamuzu, Mzuzu, Queen Elizabeth and Zomba) in Malawi. The study design was descriptively cross sectional and utilized a quantitative data collection and analysis method. All available 48 registered nurses in the surgical ward of four central hospitals and 100 patients that were admitted in the ward during the time of study were recruited. A 3-point scale rating consisting of compliance (C = 1), partial compliance (C 1.0-0.5) and non compliance (C 0.5-0.0) was used to describe the nurse midwives compliance with the process standards of care. Results show that nurses in all the 4 central hospitals partially complied with assessment and planning standards. During assessment, the nurses assessed the physical aspects of care but did not assess the psychological, spiritual and cultural aspects of care. At planning the nurses assigned and delegated tasks based on the knowledge and skills of the provider selected but did not comply with factors related to safety, effectiveness and cost of care. All the facilities fully complied with implementation standard because they implemented care in a safe and appropriate manner and communicated with patients/ significant others and other health care providers. However, regarding systematic and ongoing evaluation of patients’ condition only Mzuzu Central hospital partially complied while the rest of the facilities were not compliant. All the facilities did not comply with documentation standard of care because the patient records were not legible and did not precisely depict comprehensiveness of care nor bore signatures of the implementers of the care. Results are discussed by relating the level of compliance to standards and the quality of patient care.

Looking Through Different Eyes: Weaving Stories of Hope and Healing in the Work of Hospice, Renewal, and Ritual

1.Recognize and discuss the importance of the stories in hospice work as tools for renewal and healing.2.Describe insights from stories by looking through both a personal and profession lens.3.Recognize and honor tradition and one's own personal journey and its unique role in empowering enhanced care.4.Renew a sense of one's own gifts in healing and hope through ritual. The presenter will guide the audience on a shared journey of “Looking Through Different Eyes” and weaving stores of hope and healing. Professional caregivers will be given the opportunity to rest, to renew, and to hear stories while finding healing ways for their own path of cumulative losses. This session offers the opportunity to look and listen to stories, the humor in heartaches, and how professionals can identify the gifts and the signs in themselves of stress and trouble. Practical tips for taking care of self as well as others will also be discovered and remembered. The plenary will end with a ritual of healing intended to leave participants lighter for the conference and for their own work where so much is given to so many. Healing Heartaches, Stories of Loss and Life, a new book written by the presenter will be available for sale at the conference with a book signing hosted by the AAHPM. Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious, and Existential Aspects of Care; Cultural Aspects of Care

Latest Updates in Geriatrics and Palliative Medicine: A Skill-Based Immersive Learning Workshop (P3)

1.Discuss the common and important clinical problems encountered in providing palliative care for older adults with serious life-limiting illnesses.2.Apply best practices to solve problems outlined in case scenarios. Hospice and palliative care providers frequently care for older adults. There are special considerations required for effective assessment and palliation of symptoms in the elderly. This workshop will provide the opportunity to learn the latest updates in the assessment and management of common problems in the geriatric population and apply problem-solving strategies in small-group settings. Topics that will be addressed include (1) assessment and management of pain including dosing strategies for the geriatric patient and (2) assessment and management of key and challenging non-pain symptoms including complex wound care, dementia, and delirium. Physical Aspects of Care; Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious, and Existential Aspects of Care; Cultural Aspects of Care; Care of the Imminently Dying Patient

Intoxicated by My Illness: Artistic Expressions of Terminal Illness and Grief (323)

1.Compare and contrast the artists’ ideal patient-doctor relationship at the end of life.2.Discuss how the terminally ill person can use illness to reform and energize the self and community with artistic expressions.3.Discuss how suffering is both personal and universal. Three artists have captured the experience of dying and grief with their artistic expressions. Goethe has stated “seeds for the planting must not be grounded.” This became a revelation to Kathe Kollwitz with the loss of her son in World War I. Her grief provided important purpose and energy to her lithographs woodcuttings and sculptures. She said, “I do not want to go until I have faithfully made the most of my talent and cultivated the seed that was placed in me until the last twig has grown.” Anatole Broyard, a literary critic, recorded his illness over course. His prose “Intoxicated by My Illness” expresses the creative force of terminal illness. “A critical illness is like a great permission and authorization or absolving. It's all right for a threatened man to be romantic even crazy if he feels like it. All your life you think you have to hold back your craziness but when you are sick you can let it out in all its garish colors.” Robert Pope died at age 35 from side effects of chemotherapy. He recorded his experience in painting. “One positive quality of cancer or any serious illness is the way it causes us to focus and consider priorities perhaps even for the first time.” This workshop will compare and contrast the artists’ ideal patient-doctor relationship at the end of life. We will discuss how the terminally ill person can use illness to reform and energize the self and community with artistic expressions. We will explore how suffering is both personal and universal. The prose of Broyard suggests psychological isolation from his support network. Broyard also makes strong recommendations about how caregivers should interact with patients. We will explore these recommendations as myth or reality. Finally, we will discuss the visual arts in grief and loss. Psychological and Psychiatric Aspects of Care; Spiritual, Religious, and Existential Aspects of Care; Cultural Aspects of Care

Pain Theater: How to Talk to Your Patients When Their Pills Are “Stolen”—Again (407)

1.Identify common red flags for opioid misuse.2.Discuss how to respond to signs of opioid misuse with empathy and appropriate limit-setting.3.Interpret positive and negative urine drug screens. Many practitioners dread confronting a patient about behaviors such as repeatedly “losing” pills, getting opioid prescriptions from multiple providers, or using street drugs concurrently with opioids. While many of these patients may simply need better pain management, some may be abusing the medications, struggling with addiction, or diverting medications. Palliative care centers are seeing a growing number of such difficult-to-manage patients in consultation, and hospices struggle with the barriers that active substance use disorders create to providing quality end-of-life care. Most hospice and palliative care clinicians do not receive education in how to communicate with patients with life-limiting illnesses who also exhibit aberrant drug-taking behavior. This session uses a technique called “Pain Theater” to teach communication skills around opioid misuse and addiction disorders in the hospice and palliative care population. Pain Theater is an educational innovation that was introduced at the 2010 AAHPM Educational Exchange to overwhelmingly positive audience response. The centerpiece of this year's session is the opportunity to see how an expert clinician communicates in a difficult encounter with a patient with newly diagnosed metastatic cancer and a history of chronic pain opioid misuse and a recent positive urine drug screen. The case will be acted out in front of the audience by two of the presenters. A third presenter facilitates the session, soliciting audience feedback to identify the specific communication skills that were used and “pausing” the encounter to ask for suggestions on how to proceed in a way that sets limits, but maintains the rapport necessary to develop a treatment plan that addresses, both, opioid misuse and pain. Through this exercise the audience sees the real-time consequences of skillful communication and envisions how they could adopt these strategies with their own patients. Structure and processes of Care; Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious, and Existential Aspects of Care; Cultural Aspects of Care; Ethical and Legal Aspects of Care

Words That Work: Patient-Centered Strategies for Difficult Conversations (P19)

1.List common patient and family frameworks that create challenging communication scenarios for palliative care clinicians.2.Describe communication strategies that effectively reframe difficult conversations into collaborative patient-centered, goal-directed care planning discussions.3.Cite model dialogue that can enhance communication in specific challenging clinical scenarios. Effective communication is a core skill requirement for quality palliative care. Skillful palliative care clinicians achieve successful communication by serving as interpreters bridging the world of medicine that focuses on communicating facts about diagnosis prognosis treatment plans to the world of patients and families who worry about their illness in terms of values purpose and meaning and how to make trade-offs given current and future quality of life. Effective strategies include creating safe environments that invite patients, families, and clinicians to express their opinions frankly and using meta-communication techniques of simultaneously listening to each person's narrative and monitoring one's own words to match others as a way to find common ground and demonstrate that all the participants have been heard. This workshop is responding to the request to expand our 1-hour presentation from the 2010 AAHPM meeting to include more time to review and analyze successful communication strategies and conduct as well as to debrief and discuss role play demonstrations in small groups. For the role playing, we will break into small groups and invite participants to pose their own communication challenges from topics such as eliciting goals of care, discussing miracles, managing uncertainty, dealing with denial, and responding to clinician and family requests to “stop the torture” or “get the DNR.” We will enact the same conversation 2–3 times using different communication strategies to show how the process changes when any one of the four components (ie, words, attitude, body language, and timing) shifts. Our work is based on ethnographic research observing expert clinicians, conducting consults, and our experience translating this research into practical education strategies for medical students and residents. This session is designed for less-experienced practitioners who want to improve their skills as well as educators seeking effective teaching strategies. Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious and Existential Aspects of Care; Cultural Aspects of Care

Scotch, Cigarettes, and Soldiers: Understanding the Unique Needs of Veterans at the End of Life (P22)

More veterans are expected to die this year than in all of World War II. Approximately 29% of all deaths in the United States per year are veteran deaths, yet less than 4% of veterans die in a veterans affairs (VA) facility. This presentation will assist the learner in identifying the unique needs of veterans at end of life, address the strategies in place to improve access to hospice and palliative care for veterans, and increase awareness of hospice veteran partnerships in the community. Benefits and services that are available to veterans outside a VA healthcare facility will also be presented. Structure and Processes of Care; Physical Aspects of Care; Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious, and Existential Aspects of Care; Cultural Aspects of Care; Care of the Imminently Dying Patient; Ethical and Legal Aspects of Care

International Emergency Medicine

International Emergency Medicine

The Psychosocial Oncology Learning Assessment: A Province-Wide Survey of Cancer Care Providers’ Learning Needs

A psychosocial oncology learning needs assessment was developed and offered online to cancer care providers in a variety of settings across all health regions in British Columbia. The purpose was to better understand the psychosocial learning needs of cancer care providers and to use this knowledge to shape continuing education priorities. Respondents' preferred learning formats, access to technology and barriers to accessing psychosocial learning opportunities were also assessed. Cancer care providers including radiation therapists, social workers, dieticians, pharmacists, physicians and nurses in both community and agency settings were surveyed. Two hundred and sixty-seven people completed the survey. Key learning needs identified included cultural aspects of care, symptom management, treating the anxious patient, self-care for the professional, care of elderly patients, basic cancer-related medical issues surrounding care and ethics. Community respondents indicated more needs than agency respondents. On-site training was the most preferred learning format, and time constraints were the biggest barrier to accessing learning opportunities. Participants had access to technology. Next steps include conducting key informant and focus group interviews to determine if interest in a learning need is the same as a relevant knowledge and practice gap. This research suggests that cancer care providers are interested in learning more about the psychosocial issues related to cancer care.

Uncertainty of Advance Care Planning Treatment Preferences among Diverse Older Adults

1.Recognize that many patients may not be able to make definitive treatment decisions in advance.2.Identify the level of uncertainty patients experience during advance care planning when making treatment decisions based on hypothetical scenarios.3.Discuss the patient characteristics associated with uncertainty when making treatment decisions based on hypothetical scenarios. I. Background. Older persons may be unprepared to make advance treatment decisions and uncertain about their preferences. II. Research Objectives. Using a hypothetical scenario, we assessed certainty about treatment preferences among older adults. III. Methods. Two hundred five English- and Spanish-speakers aged 50 years were recruited from a county hospital in San Francisco. The scenario: Imagine your doctor said that you have a serious disease and may die within 6 months. You then get very sick. Your doctor thinks that life-support treatments will NOT help you live longer and will NOT cure your disease. Participants were asked to choose: all life support (LS); try LS with an option of stopping; or no LS, and to rate their decisional certainty (very sure, sure, not so sure, not sure at all). Participants were considered completely certain if they reported very sure. IV. Results. Mean age of participants was 61 years and 31% were Latino, 25% white, 24% African American, 9% Asian/Pacific Islander, 10% multi-ethnic, 52% female, 40% had limited literacy, 29% were Spanish-speaking, and 69% had fair-to-poor health status. Ninety-two participants (45%) reported not being entirely certain of their preferences: 21% wanted all LS, 30% to try LS, and 49% no LS. Uncertainty did not vary by treatment preference (P=.35). In adjusted multivariable analyses, uncertainty was associated with being Asian/Pacific Islander (OR 4.9; 95% CI, 1.4–16.9) and Latino vs. White (OR 2.5; 95% CI 1.0–5.8); having limited vs. adequate literacy (OR 1.9; 95% CI 1.0–3.7), and fair-to-poor vs. good-to-excellent health (OR 2.0; 95% CI 1.0–4.2). V. Conclusion. Approximately half of diverse older adults were uncertain about a scenario-based advance treatment decision. Uncertainty was more common among minorities and participants with limited literacy and poor health. VI. Implications for Research, Policy, and Practice. Many patients may be unable to make definitive advance treatment decisions. Culturally sensitive, literacy-appropriate tools are needed to help patients prepare for decision-making about their medical care. Structure and Processes of Care; Cultural Aspects of Care

Comfort Zone Camp

1.Discuss national awareness to the unmet need of grieving children.2.Describe effective coping strategies and tools.3.Discuss giving grieving children a voice and a place. Children grieve differently from teens and adults. Lynne Hughes, CEO and founder of Comfort Zone Camp, the nation's largest bereavement camp, will discuss the impact age can make on the grief process. She will discuss what grieving children need, how we can support them, what boundaries should be set for them, and how to help teach coping skills for the different age groups. Bereaved children have been categorized as the nation's forgotten mourners. These children need a voice and a place. Lynne will discuss how to be an ambassador for grieving children and bereaved families. She will also discuss what to say and what not to say, using common themes discovered through Comfort Zone Camp's 10 years of serving bereaved children and teens. By bringing 65-plus grieving children together in a rustic camp environment without the distractions of the outside world, Comfort Zone Camp has demonstrated the importance of breaking the isolation death often brings, and returning a feeling of normalcy—even for a brief moment. Lynne will discuss how to help grieving children share their stories, remember their loved ones, and rebuild trust and friendships. In addition, Lynne will discuss the logistics involved in hosting a bereavement camp—from fundraising to recruiting and training volunteers. Structure and processes of Care; Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious, and Existential Aspects of Care; Cultural Aspects of Care

A Framework for Assessing Quality Indicators for Cancer Care at the End of Life

Patients with advanced cancer often do not receive high-quality pain and symptom management or support with coordination of care, communication, and decision making. Implementing quality indicators that are reflective of the scope of care, feasible to implement, and supported by evidence might help to identify areas and settings most in need of improvement. However, recent reviews and policy initiatives identified only a few indicators that met these criteria. To help advance quality indicator development and implementation in this area, we developed a conceptual framework based on previous related initiatives, updated reviews of end-of-life cancer quality indicators and relevant data sources, and expert input. The framework describes five steps for developing and assessing a quality indicator for end-of-life care, defining the 1) population of focus, 2) broad quality domains, 3) specific target areas, 4) steps of the care process, and 5) evaluation criteria for quality indicators. The defined population includes seriously or terminally ill cancer patients, who are unlikely to recover or stabilize, and their families. Domains include the structure and processes of care; the physical, psychiatric, psychosocial, spiritual, and cultural aspects of care; as well as the care of the imminently dying, ethical and legal issues, and the delivery of care. Evaluation criteria include importance; scientific acceptability, including validity, evidence to improve outcomes, reliability, responsiveness, and variability; usability; and feasibility, including ready data sources. By using this conceptual framework, indicator developers, researchers, and policymakers can refine and implement indicator sets to effectively evaluate and improve care at the end of life.

Somali women's experience of childbirth in the UK: Perspectives from Somali health workers

Objective to conduct a qualitative study of perceptions of experiences of childbirth from Somali health workers in the UK. Design & setting in depth narrative interviews at community centres and places of work in London. Participants eight Somali women aged between 23 and 57 years. The interviewees worked within the health sector in the UK and/or as nurses or gynaecologists in Somalia. Six of the women had also given birth in the UK. Key findings mismanagement of care of female circumcision provided during pregnancy and labour leads to problems at birth for many Somali women. The importance of Somalia's oral culture is not recognised when addressing communication barriers and continuity of care is lacking but important. Somali women also felt that midwives held stereotyped and negative attitudes towards them. Existing pressures as a consequence of migration were compounded by these experiences of childbirth in the UK. Key conclusions issues concerning female circumcision, verbal communication, cultural aspects of care and pressures that were a consequence of migration play a part in the experience of childbirth in the UK for Somali women. Implications for practice midwives need to possess the necessary clinical knowledge and skills to deal with women who have been circumcised and the issue needs to be raised early in the pregnancy. Attention needs to be paid to ensure continuity of care, maximising verbal communications and challenging stereotypical views of Somali women.

Nursing documentation: non-physical dimensions of end-of-life care in acute wards

to explore discrepancies between nurses' knowledge and their documentation of issues of psychosocial, spiritual and cultural aspects of palliative care, evidenced clearly in recent nursing research into end-of-life care in an acute care, teaching hospital. the study involved a retrospective patient case-note audit of an opportunistic sample of 20 patients deceased recently and interviews of the two nurses most involved in the care of each patient (n=40). this research indicates that nurses in acute care settings often recognize, sometimes explore, but infrequently document psychosocial, spiritual and cultural aspects of care. there is a strong need for: (1) education about both the impact of non-physical dimensions of patients' lives and the effective documentation of these dimensions; and (2) up-grading of documentation tools to better facilitate documentation of non-physical aspects of palliative care.

Help seeking and satisfaction among Latinas: The roles of setting, ethnic identity, and therapeutic alliance

AbstractThis study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith‐based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299–312, 2005.

The patient experience in emergency departments: a review of the literature

This paper analyses the literature on the patient experience within emergency departments. We identify six themes within the literature: waiting times, communication, cultural aspects of care, pain, the environment and dilemas in accessing the patient experience. Overall, the literature has a North American bias and is largely quantitative in approach. Although levels of patient satisfaction are high, a number of issues arise within the review, which suggest areas where quality of care could improve. We also identify the problematic nature of accessing the patient experience and suggest future areas for researchers to explore.

Transcultural nursing: how do nurses respond to cultural needs?

The aim of the study was to explore how nurses responded to the cultural needs of their clients. From the transcultural point of view, healthcare providers must deliver a service that is culturally sensitive and appropriate. However, for a variety of reasons, there is growing concern that the cultural healthcare needs of minority ethnic groups are not met adequately. This study was done to outline nurses' activity in transcultural care. Empirical data were obtained from a sample of registered nurses (n = 126) who were invited to complete questionnaires pertaining to cultural care. As a result of data analysis, the quantitative findings are presented as tables and the qualitative data as categories and themes. The findings suggest that most respondents felt that patients' cultural needs should be given consideration. Cultural aspects of care seem to be a feature of the overall nursing picture within a multicultural context of health care. Many participants claimed that they responded to the cultural needs of patients. Some felt that patients' cultural needs are adequately met; such needs are perceived as religious practices, diets, communication, dying, prayer and culture. Furthermore, a significant number of respondents suggested that they would like further education in meeting the cultural needs of their patients. This study offers some insights into transcultural healthcare practice, and, in accordance with the findings, identifies strategies for improving these practices for nursing and nurse education.