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Addressing cultural issues is part of good education
Questions during one-on-one teaching
Except for the use of an interpreter, teaching techniques need not be altered when the patient is from another country.
"Just as we approach education in general teaching, patients from other cultures should be done the same way. Ask the patient questions and involve family members," says Yvonne Brookes, RN, manager of clinical instructors and patient education liaison for Baptist Health South Florida in Coral Gables.
Find out a little bit about patients and what is important to them. Tell them what they need to do and find out how they might follow through at home - what might work best for them. To determine if it is aligned (rather than merges) with their belief system, get to know the patient's story. A lot can be learned upon admission by asking a few questions.
Making observations is helpful too, says Brookes. Watch to see who is coming to see the patient, how he or she interacts with family members, what he or she eats, and what is left on the tray.
"One of the biggest barriers to education is communication. We must learn how to have meaningful communication with patients, verbal as well as nonverbal," says Brookes.
At Children's Hospital Central California all educational handouts and videos are translated into Spanish because a large percentage of the patient base is Hispanic. There also are Spanish on-demand TV channels, says Leslie Catron, RN, a clinical educator at the health care facility in Madera.
While interpreters can always be present in classes to interpret for patients and family members, it is best to tailor the curriculum to the target culture as well.
For example, Harborview Medical Center in Seattle began several years ago to have multicultural diabetes outpatient classes. Each year they host four classes focusing on people from different countries at each one — such as Cambodia or Vietnam — explains Ella Mae Kurashige, RN, BSN, MSN, manager of patient education at Harborview Patient and Family Resource Center.
Before each class, a meeting of all the presenters is held with the cultural mediator from interpreter services. At that time, the mediator explains the traditions, beliefs, and concerns of the people who might attend the class and discusses any contradictions their view may pose with Western medicine.
"We need to know the participants' background before the class so we can address it or explain the information differently so there is not confusion," says Kurashige.
While currently the multicultural classes focus only on diabetes, staff members are looking at using this model to teach patients how to manage other chronic diseases. To help staff become more competent teachers when working with multicultural patients, Kurashige plans to add a patient education return demonstration to the annual staff competencies. Nurses would be asked to show how they would teach a patient from another country to give insulin. They would need to know what tools to use, what resources to call upon, how to teach the skill, and how to assess whether or not the patient understood.