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Sometimes, health care professionals don’t have a clue when it comes to educating patients from diverse cultures. That’s why patient and family education services at the University of Washington Medical Center in Seattle created Culture Clues, a front-and-back printed sheet designed to increase awareness about the concepts and preferences of patients from other countries who access medical care at the institution.
"Staff told us they wanted something that was a just-in-time intervention they could easily access. They wanted practical information they could use at the time of the encounter, when they have to see a patient and want to make sure they have a good communication interaction with them," says Etta Short, MS, a health educator at the University of Washington Medical Center in Seattle and a member of the committee who developed the sheets.
To begin the process, the staff development committee, which is a branch of the hospitalwide patient education committee, looked at what resources already were available, how they were used, and if they were effective. They found that most floors have a nursing guide on cultures available, but it’s difficult to find the informative book quickly.
Cultural information also is available via a web site designed by a sister medical center in the area; but is so comprehensive, people don’t have time to sift through all the information when they have a teaching need. (For more information about these resources, see resource box, p. 57.)
Taking into account the need for something quick and comprehensive, the idea for a clue sheet was born, and a team of six people set out to create the first sheet for the Russian patient group because it was the highest number of interpreter encounters. The Russian Culture Clue sheet was completed in December 1999. A Spanish sheet soon followed, and then Vietnamese and Korean Culture Clues were written.
Chinese, Somali, African-American, and American Sign Language are in the works. "We are going to create an American Sign Language Culture Clue sheet because we discovered a huge population of folks who use sign language, and we were told it is a culture unto its own as well," says Short.
To help determine content, team members did an informal survey of staff and found that most were interested in how cultures define illness, how they make decisions about medical issues, and what their norms are regarding touch. Therefore, each Culture Clue sheet has practical information under those three headings. (See example of a cultural clue sheet, inserted in this issue..)
Following a literature search for information on the culture the team is writing the sheet for, two team members for each of the three categories read the articles with an eye for information that pertains to either touch, decision making, or meaning of illness. The small groups then present the information to their team, and together they decide the relevant issues. Following this process, each group writes its section and the team leader polishes it so the three sections have a similar tone.
Once the rough draft is complete, three people with a medical background from the culture being addressed review the material and offer recommendations for revisions. "At that point, we boil the information down to two pages and feel confident that what we are sharing is relevant for our community, those cultures, and the medical issues," says Short.
The Culture Clue sheets are laminated and distributed housewide and are made available on the institution’s web site. Each department distributes them in the way that best meets their needs. For example, some managers post them on the lunchroom walls while others include them in the procedure book that is kept on the unit. At the Women’s Health Care Center, nurses gather important documents for each patient’s chart the day before their scheduled visit that might include lab forms, educational materials, and the appropriate culture clue for the physician to review.
New nurses receive hourlong orientation
In addition to distribution efforts by each unit, staff are made aware of Culture Clue sheets in three other ways. All new nurses learn about this resource during an hourlong orientation on patient education resources. An on-line, 30-minute inservice on patient care resources for nurses also discusses Culture Clue sheets, and they also are discussed during an eight-hour workshop on how to write and format educational materials.
The goal of Culture Clues is to increase confidence in communication for education. Therefore, an evaluation currently is being conducted to determine if the tool is effective. Questionnaires are being filled out at staff meetings to see if people are aware of the Culture Clue sheets and if they have read them. Those who have are asked to evaluate on a scale of one to five whether Culture Clue sheets contain useful information to provide culturally sensitive care, are easy to read, increase knowledge of the culture, are accessible when needed, and increase confidence in communicating with patients from another culture.
"We want Culture Clues to be an awareness tool; it isn’t meant to be all you need to know about a culture. We hope it is an appetizer in a way for further review and study about other cultures," says Short. n
• Etta Short, MS, Health Educator, University of Washington Medical Center, Patient and Family Education Services, Box 354618, 1959 N.E. Pacific St., Seattle, WA 98195. Telephone: (206) 598-7448. E-mail: firstname.lastname@example.org.
• Culture Clues are available on the University of Washington Medical Center Patient and Family Education web site: http://depts.washington.edu/pfes/.
• Culture and Nursing Care, A Pocket Guide by J.G. Lipson, S.L. Sibble, and P.A. Minarik, published by University of California at San Francisco Nursing Press, 1996, is available on the units at Washington State Medical Center for further reference. It can be purchased for $21.95 on the web site: www.amazon.com.
• EthnoMed, a web site with a multitude of cultural materials: http://healthlinks.washington.edu/clinical/ethnomed.