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(Editor’s note: In this first part of a two-part series on the growing Hispanic population, we tell you what specific challenges you’ll face and how to overcome them. In next month’s issue, we’ll tell you how to attract and serve the Hispanic population.)
The woman wanted directions to the same-day surgery department within a large hospital complex. She was supposed to meet a family member undergoing a surgical procedure who needed a ride home after discharge. Although she went to the main information desk, no one could help her. None of the staff at the front desk spoke Spanish. After waiting for at least 20 minutes for a Hispanic member of the housekeeping staff to answer a page to the front desk, the woman returned home to get a bilingual neighbor who could direct her to the right place. Luckily, she arrived at the same-day surgery department before her family member was discharged.
A 57.5% increase in the Hispanic population in the United States between 1990 and 2000, from 22.4 million to 35.3 million, according to the 2000 U.S. Census, means changing the way same-day surgery services are offered. (To find statistics for your area, see "Sources and resources" at the end of this article.)
The most obvious barrier for most Hispanic patients to overcome is the language barrier, says Carlos A. Rodriquez, MD, a Geneva, IL-based gastroenterologist who recently opened Kendall Pointe Surgical Center, a surgery center that is designed to serve a multicultural population in Geneva and the surrounding area. "For many years, Hispanic patients could not find a bilingual employee at the local hospital front desk giving directions or on the telephone to make appointments," Rodriquez explains. His surgery center has Spanish-speaking employees in all of the key patient and family contact areas such as the front desk. "We also try to have one bilingual employee with the patient throughout the whole process to minimize the number of family members who are needed to translate," he adds.
Family plays an important part in the Hispanic patient’s trip to any health care provider, says Armando Riera, BSN, RN, CNOR, nurse liaison at Jackson Memorial Hospital in Miami. In addition to serving as translators, they often are involved in decisions about the patient’s care, he adds. "It is just as important to explain diagnoses and surgical treatments to family members as it is to explain them to the patient," Riera says. Not only does this improve aftercare, but it also reassures everyone that the patient is receiving the best care, he adds.
Because Hispanic families include not only parents and children but also cousins, aunts, and other extended family members, be ready for a larger than average group of people to accompany the patient on the day of surgery, says Riera. "Not only does the patient want the extra support of family translators, but family members appreciate each other’s support while waiting," he says.
For these reasons, Riera’s same-day surgery staff is prepared to direct family members to larger waiting areas so they can be together, and family members are allowed to take turns sitting with the patient in the pre-op and post-op areas when appropriate. "We can’t allow more than one family member at a time to stay with the patient, but by letting them switch out during the process, they all feel like they have done their part in caring for the family member," he explains.
When designing his same-day surgery center, Rodriquez made sure that in addition to a general waiting area, there were consultation rooms to which a family could be directed to wait. "These rooms also give us a private area in which we can talk to the family all at once," he adds.
Another aspect of Hispanic culture that needs to be understood is the religious aspect, says Riera. "The Hispanic population is very religious, usually Catholic, and the people often rely upon religious talismans for luck," he says.
Be prepared for the patient to ask to carry a picture of the Virgin Mary or a cross into surgery, he suggests. Also, don’t be surprised if a priest is included in the group of people accompanying the patient, he adds. Decisions as to what items can go with the patient into the pre-op, operating room (OR), and recovery areas are made on a case-by-case basis with patient safety the primary concern, says Riera. "If the item doesn’t present a risk in any way, we let them take it," he says.
When the item can’t accompany the patient, staff explain the reasons in a way that shows respect for the patient’s beliefs, Riera adds. First, tell the patient that you understand how important the item is to him or her, then explain why it might pose a risk to the patient’s safety in the OR, he suggests. Finally, ask which family member the patient would like to safeguard the item and promise to get it back to the patient at the earliest moment after surgery, he adds.
Patient education for Hispanics also may present challenges, says Rodriquez. His staff has created some Spanish-language patient education materials, but most companies that produce patient education materials used by surgeons and surgery centers offer the publications in Spanish, he says. [For examples of Spanish and English patient handouts, go to www.same-daysurgery.com. Click on "toolbox" and scroll down to "Patient Documentation/Patient Education" to see handouts on post-op pain and suture care. You’ll need your subscriber number to access the site, which is printed above your name on your SDS mailing label. Your user name is your subscriber number, and your password is sds in small letters plus your subscriber number (no spaces). If you need your subscriber number, contact customer service at (800) 688-2421 or firstname.lastname@example.org.]
In addition to educational materials, make sure you have Spanish-language maps of your facility if you are a hospital-based program in a large complex, says Riera. "We also have Spanish-language videos for education as well," he adds. His maps and videos were produced in-house, but Riera points out that many patient education videos are available in Spanish.
While language, family, and religion are the key areas that must be evaluated if a same-day surgery manager wants to address Hispanic needs, there are other cultural beliefs that need to be taken into account, says Riera. Reliance on pharmacists and over-the-counter drugs and use of herbs and home remedies increase the SDS staff’s need to ask about other medications and treatments the patient may have used, says Riera.
There are resources for same-day surgery managers who want to know more about ensuring their programs meet the needs of Hispanic patients, Rodriquez says. The Washington, DC-based National Alliance for Hispanic Health and a web site sponsored by Boston-based Management Sciences for Health offer information on setting up services that meet cultural and linguistic needs of Hispanic populations. (See "Sources and resources," below)
Rodriquez’ surgery center, with its multicultural focus, has spurred changes in the way other programs in the area address the needs of Spanish-speaking patients. "We are now seeing an increase in the number of bilingual employees available to help Hispanic patients at all other facilities, especially the hospitals," he says. "This was not the case when we first applied for our certificate of need for our center."
For more information about Hispanic-focused programs, contact:
• Carlos A. Rodriquez, MD, Medical Director and President, Kendall Pointe Surgical Center, 302 Randall Road, Suite 304, Geneva, IL 60134. E-mail: email@example.com.
• Armando Riera, RN, BSN, CNOR, Nurse Liaison, Department of Oral Surgery, Jackson Memorial Hospital, 1611 N.W. 12th Ave., Miami, FL 33136. E-mail: firstname.lastname@example.org.
To find statistics related to the Hispanic population in your area, go to the Census 2000 web site at www.census.gov/dmd/www/2kresult.html. Click on Summary File 1, then choose the desired state.
To find information that will help you set up services that address the Hispanic population, contact:
• The Management Sciences for Health, 165 Allandale Road, Boston, MA 02130-3400. Telephone: (617) 524-7799. Fax: (617) 524-2825. Web: erc.msh.org/quality&culture. The organization’s web site helps health care organizations provide culturally competent services for different populations. Common health problems, cultural beliefs that may affect health care, and suggestions on how to meet a specific population’s needs are addressed.
• The National Alliance for Hispanic Health, 1501 16th St. N.W., Washington, DC 20036. Telephone: (202) 387-5000. Fax: (202) 797-4353. Web site: www.hispanichealth.org. The alliance offers a variety of publications that recommend ways to set up health services that address the needs of the Hispanic population. Descriptions and prices for the publications are included on the web site.